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1. The role of bronchoscopy in patients with SARS-CoV-2 pneumonia

Author

Marisol Arenas-De Larriva, Roberto Martín-DeLeon, Blanca Urrutia Royo, Iker Fernández-Navamuel, Andrés Gimenez Velando, Laura Nuñez García, Carmen Centeno Clemente, Felipe Andreo García, Albert Rafecas Codern, Carmen Fernández-Arias, Virginia Pajares Ruiz, Alfons Torrego Fernández, Olga Rajas, Gorane Iturricastillo, Ricardo Garcia Lujan, Lorena Comeche Casanova, Albert Sánchez-Font, Ricardo Aguilar-Colindres, Roberto Larrosa-Barrero, Ruth García García, Rosa Cordovilla, Ana Núñez-Ares, Andrés Briones-Gómez, Enrique Cases Viedma, José Franco, Javier Cosano Povedano, Manuel Luis Rodríguez-Perálvarez, Jose Joaquin Cebrian Gallardo, Manuel Nuñez Delgado, María Pavón-Masa, Maria del Mar Valdivia Salas, and Javier Flandes

Subjects
Medicine
Abstract

Background The role of bronchoscopy in coronavirus disease 2019 (COVID-19) is a matter of debate. Patients and methods This observational multicentre study aimed to analyse the prognostic impact of bronchoscopic findings in a consecutive cohort of patients with suspected or confirmed COVID-19. Patients were enrolled at 17 hospitals from February to June 2020. Predictors of in-hospital mortality were assessed by multivariate logistic regression. Results A total of 1027 bronchoscopies were performed in 515 patients (age 61.5±11.2 years; 73% men), stratified into a clinical suspicion cohort (n=30) and a COVID-19 confirmed cohort (n=485). In the clinical suspicion cohort, the diagnostic yield was 36.7%. In the COVID-19 confirmed cohort, bronchoscopies were predominantly performed in the intensive care unit (n=961; 96.4%) and major indications were: difficult mechanical ventilation (43.7%), mucus plugs (39%) and persistence of radiological infiltrates (23.4%). 147 bronchoscopies were performed to rule out superinfection, and diagnostic yield was 42.9%. There were abnormalities in 91.6% of bronchoscopies, the most frequent being mucus secretions (82.4%), haematic secretions (17.7%), mucus plugs (17.6%), and diffuse mucosal hyperaemia (11.4%). The independent predictors of in-hospital mortality were: older age (OR 1.06; p

Published
2021
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2. The burden of mild asthma: Clinical burden and healthcare resource utilisation in the NOVELTY study

Author

Sarowar Muhammad Golam, Christer Janson, Richard Beasley, J Mark FitzGerald, Tim Harrison, Bradley Chipps, Rod Hughes, Hana Müllerová, José María Olaguibel, Eleni Rapsomaniki, Helen K. Reddel, Mohsen Sadatsafavi, Gabriel Benhabib, Piushkumar Mandhane, Xavier Bocca Ruiz, Andrew McIvor, Ricardo del Olmo, Bonavuth Pek, Raul Eduardo Lisanti, Robert Petrella, Gustavo Marino, Daniel Stollery, Walter Mattarucco, Meihua Chen, Juan Nogueira, Yan Chen, Maria Parody, Wei Gu, Pablo Pascale, Kim Ming Christopher Hui, Pablo Rodriguez, Manxiang Li, Damian Silva, Shiyue Li, Graciela Svetliza, Lijun Ma, Carlos F. Victorio, Guangyue Qin, Roxana Willigs Rolon, Weidong Song, Anahi Yañez, Wei Tan, Stuart Baines, Yijun Tang, Simon Bowler, Chen Wang, Peter Bremner, Tan Wang, Sheetal Bull, Fuqiang Wen, Patrick Carroll, Feng Wu, Mariam Chaalan, PingChao Xiang, Claude Farah, Zuke Xiao, Gary Hammerschlag, Shengdao Xiong, Kerry Hancock, Jinghua Yang, Zinta Harrington, Jingping Yang, Gregory Katsoulotos, Caiqing Zhang, Joshua Kim, Min Zhang, David Langton, Ping Zhang, Donald Lee, Wei Zhang, Matthew Peters, Xiaohe Zheng, Lakshman Prassad, Dan Zhu, Helen Reddel, Fabio Bolivar Grimaldos, Dimitar Sajkov, Alejandra Cañas Arboleda, Francis Santiago, Carlos Matiz Bueno, Frederick Graham Simpson, Dora Molina de Salazar, Sze Tai, Elisabeth Bendstrup, Paul Thomas, Ole Hilberg, Peter Wark, Carsten Kjellerup, José Eduardo Delfini Cançado, Ulla Weinreich, Thúlio Cunha, Philippe Bonniaud, Marina Lima, Olivier Brun, Alexandre Pinto Cardoso, Pierre-Régis Burgel, Marcelo Rabahi, Christos Chouaid, Syed Anees, Francis Couturaud, John Bertley, Jacques de Blic, Alan Bell, Didier Debieuvre, Amarjit Cheema, Dominique Delsart, Guy Chouinard, Axelle Demaegdt, Michael Csanadi, Pascal Demoly, Anil Dhar, Antoine Deschildre, Ripple Dhillon, Gilles Devouassoux, J. Mark FitzGerald, Carole Egron, David Kanawaty, Lionel Falchero, Allan Kelly, François Goupil, William Killorn, Romain Kessler, Daniel Landry, Pascal Le Roux, Robert Luton, Pascal Mabire, Guillaume Mahay, Yumiko Ide, Stéphanie Martinez, Minehiko Inomata, Boris Melloni, Hiromasa Inoue, Laurent Moreau, Koji Inoue, Chantal Raherison, Sumito Inoue, Emilie Riviere, Motokazu Kato, Pauline Roux-Claudé, Masayuki Kawasaki, Michel Soulier, Tomotaka Kawayama, Guillaume Vignal, Toshiyuki Kita, Azzedine Yaici, Kanako Kobayashi, Sven Philip Aries, Hiroshi Koto, Robert Bals, Koichi Nishi, Ekkehard Beck, Junpei Saito, Andreas Deimling, Yasuo Shimizu, Jan Feimer, Toshihiro Shirai, Vera Grimm-Sachs, Naruhiko Sugihara, Gesine Groth, Ken-ichi Takahashi, Felix Herth, Hiroyuki Tashimo, Gerhard Hoheisel, Keisuke Tomii, Frank Kanniess, Takashi Yamada, Thomas Lienert, Masaru Yanai, Silke Mronga, Ruth Cerino Javier, Jörg Reinhardt, Alfredo Domínguez Peregrina, Christian Schlenska, Marco Fernández Corzo, Christoph Stolpe, Efraín Montano Gonzalez, Ishak Teber, Alejandra Ramírez-Venegas, Hartmut Timmermann, Adrian Rendon, Thomas Ulrich, Willem Boersma, Peter Velling, R.S. Djamin, Sabina Wehgartner-Winkler, Michiel Eijsvogel, Juergen Welling, Frits Franssen, Ernst-Joachim Winkelmann, Martijn Goosens, Carlo Barbetta, Lidwien Graat-Verboom, Fulvio Braido, Johannes in 't Veen, Vittorio Cardaci, Rob Janssen, Enrico Maria Clini, Kim Kuppens, Maria Teresa Costantino, Maarten van den Berge, Giuseppina Cuttitta, Mario van de Ven, Mario di Gioacchino, Ole Petter Brunstad, Alessandro Fois, Gunnar Einvik, Maria Pia Foschino-Barbaro, Kristian Jong Høines, Enrico Gammeri, Alamdar Khusrawi, Riccardo Inchingolo, Torbjorn Oien, Federico Lavorini, Yoon-Seok Chang, Antonio Molino, Young Joo Cho, Eleonora Nucera, Yong Il Hwang, Alberto Papi, Woo Jin Kim, Vincenzo Patella, Young-Il Koh, Alberto Pesci, Byung-Jae Lee, Fabio Ricciardolo, Kwan-Ho Lee, Paola Rogliani, Sang-Pyo Lee, Riccardo Sarzani, Yong Chul Lee, Carlo Vancheri, Seong Yong Lim, Rigoletta Vincenti, Kyung Hun Min, Takeo Endo, Yeon-Mok Oh, Masaki Fujita, Choon-Sik Park, Yu Hara, Hae-Sim Park, Takahiko Horiguchi, Heung-Woo Park, Keita Hosoi, Chin Kook Rhee, Ho Joo Yoon, Alyn Morice, Hyoung-Kyu Yoon, Preeti Pandya, Alvar Agusti García-Navarro, Manish Patel, Rubén Andújar, Kay Roy, Laura Anoro, Ramamurthy Sathyamurthy, María Buendía García, Swaminathan Thiagarajan, Paloma Campo Mozo, Alice Turner, Sergio Campos, Jorgen Vestbo, Francisco Casas Maldonado, Wisia Wedzicha, Manuel Castilla Martínez, Tom Wilkinson, Carolina Cisneros Serrano, Pete Wilson, Lorena Comeche Casanova, Lo’Ay Al-Asadi, Dolores Corbacho, James Anholm, Felix Del Campo Matías, Frank Averill, Jose Echave-Sustaeta, Sandeep Bansal, Gloria Francisco Corral, Alan Baptist, Pedro Gamboa Setién, Colin Campbell, Marta García Clemente, Michael A. Campos, Ignacio García Núñez, Jose García Robaina, Gretchen Crook, Mercedes García Salmones, Samuel DeLeon, Jose Maria Marín Trigo, Alain Eid, Marta Nuñez Fernandez, Ellen Epstein, Sara Nuñez Palomo, Stephen Fritz, José Olaguibel Rivera, Hoadley Harris, Luis Pérez de Llano, Mitzie Hewitt, Ana Pueyo Bastida, Fernando Holguin, Ana Rañó, Golda Hudes, José Rodríguez González-Moro, Richard Jackson, Albert Roger Reig, Alan Kaufman, José Velasco Garrido, David Kaufman, Dan Curiac, Ari Klapholz, Harshavardhan Krishna, Cornelia Lif-Tiberg, Daria Lee, Anders Luts, Robert Lin, Lennart Råhlen, Diego Maselli-Caceres, Stefan Rustscheff, Vinay Mehta, Frances Adams, James N. Moy, Drew Bradman, Ugo Nwokoro, Emma Broughton, Purvi Parikh, John Cosgrove, Sudhir Parikh, Patrick Flood-Page, Frank Perrino, Elizabeth Fuller, James Ruhlmann, Timothy Harrison, Catherine Sassoon, David Hartley, Russell A. Settipane, Keith Hattotuwa, Daniel Sousa, Gareth Jones, Peruvemba Sriram, Keir Lewis, Richard Wachs, Lorcan McGarvey, BioPharmaceuticals R&D [Gothenburg], AstraZeneca, Uppsala University, Malaghan Institute of Medical Research [Wellington, New Zealand], Vancouver Coastal Health Research Institute (VCH), AstraZeneca [Cambridge, UK], Complejo Hospitalario de Navarra, Woolcock Institute of Medical Research [Sydney], The University of Sydney, University of British Columbia (UBC), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Médecine de précision par intégration de données et inférence causale (PREMEDICAL), Inria Sophia Antipolis - Méditerranée (CRISAM), Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Institut Desbrest de santé publique (IDESP), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)

Subjects
Pulmonary and Respiratory Medicine, MESH: Humans, MESH: Asthma, Patient-reported measures, Respiratory Medicine and Allergy, Longitudinal studies, MESH: Patient Acceptance of Health Care, Disease burden, Healthcare resource utilisation, Mild asthma, Patient Acceptance of Health Care, Asthma, MESH: Prospective Studies, MESH: Adrenal Cortex Hormones, Adrenal Cortex Hormones, Disease Progression, Humans, Longitudinal Studies, Prospective Studies, MESH: Disease Progression, MESH: Longitudinal Studies, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Lungmedicin och allergi
Abstract

Background: Patients with mild asthma represent a substantial proportion of the population with asthma, yet there are limited data on their true burden of disease. We aimed to describe the clinical and healthcare resource utilisation (HCRU) burden of physician-assessed mild asthma. Methods: Patients with mild asthma were included from the NOVEL observational longiTudinal studY (NOVELTY; NCT02760329), a global, 3-year, real-world prospective study of patients with asthma and/or chronic obstructive pulmonary disease from community practice (specialised and primary care). Diagnosis and severity were based on physician discretion. Clinical burden included physician-reported exacerbations and patient-reported measures. HCRU included inpatient and outpatient visits. Results: Overall, 2004 patients with mild asthma were included; 22.8% experienced >= 1 exacerbation in the previous 12 months, of whom 72.3% experienced >= 1 severe exacerbation. Of 625 exacerbations reported, 48.0% lasted >1 week, 27.7% were preceded by symptomatic worsening lasting >3 days, and 50.1% required oral corticosteroid treatment. Health status was moderately impacted (St George's Respiratory Questionnaire score: 23.5 [standard deviation +/- 17.9]). At baseline, 29.7% of patients had asthma symptoms that were not well controlled or very poorly controlled (Asthma Control Test score = 2 exacerbations in the previous year. In terms of HCRU, at least one unscheduled ambulatory visit for exacerbations was required by 9.5% of patients, including 9.2% requiring >= 1 emergency department visit and 1.1% requiring >= 1 hospital admission. Conclusions: In this global sample representing community practice, a significant proportion of patients with physician-assessed mild asthma had considerable clinical burden and HCRU.

Published
2022

3. The role of bronchoscopy in patients with SARS-CoV-2 pneumonia

Author

Iker Fernández-Navamuel, Andrés Giménez Velando, Ricardo García Luján, Albert Sánchez-Font, Alfons Torrego Fernández, Marisol Arenas-De Larriva, Ana Núñez-Ares, Javier Cosano Povedano, Rosa Cordovilla, Roberto Larrosa-Barrero, Andrés Briones-Gómez, Felipe Andreo García, Roberto Martín-DeLeon, Jose Joaquin Cebrian Gallardo, Javier Flandes, Manuel Luis Rodríguez-Perálvarez, Ricardo Aguilar-Colindres, Gorane Iturricastillo, Olga Rajas, Enrique Cases Viedma, Carmen Fernández-Arias, Manuel Nuñez Delgado, Carmen Centeno Clemente, José Franco, Blanca Urrutia Royo, Maria del Mar Valdivia Salas, Albert Rafecas Codern, Virginia Pajares Ruiz, Lorena Comeche Casanova, María Pavón-Masa, Ruth García García, Laura Nuñez García, [Arenas-De Larriva,M] Dept of Bronchoscopy and Interventional Pulmonology, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, Spain. [Martín-DeLeon,R] Dept of Pulmonology, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, Spain. [Urrutia Royo,B] Pulmonary Dept, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. [Fernández-Navamuel,I, Gimenez Velando,A, Nuñez García,L] Bronchoscopy and Interventional Pulmonology Unit, Pulmonology Dept, Hospital Fundacion Jimenez Diaz, ISS-FJD, CIBERES, Madrid, Spain. [Centeno Clemente,C, Andreo García,F] Interventional Pulmonology Unit, Pulmonary Dept, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, UAB, IGTP, Badalona, Spain. [Rafecas Codern,A, Fernández-Arias,C, Pajares Ruiz,V, Torrego Fernández,A] Respiratory Dept, Hospital Santa Creu i Sant Pau, Barcelona, Spain. [Rajas,O] Interventional Pulmonology Unit, Pulmonology Dept, Hospital Universitario de la Princesa, Instituto de Investigación Princesa, Madrid, Spain. [Iturricastillo,G] Pulmonology Dept, Hospital Universitario de la Princesa, Instituto de Investigación Princesa, Madrid, Spain. [Garcia Lujan,R] Dept of Interventional Pulmonology, Hospital Universitario 12 Octubre and Hospital Univesitario Quirónsalud Madrid, Madrid, Spain. [Comeche Casanova,L] Dept of Pulmonology, Hospital Universitario Quirónsalud Madrid, Madrid, Spain. [Sánchez-Font,A] Pulmonology Dept, Hospital del Mar, CIBERES, UAB, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. [Aguilar-Colindres,R] Pulmonology Dept, Hospital del Mar, CIBERES, Barcelona, Spain. [Larrosa-Barrero,R] Pulmonary Dept, Hospital Universitario Clínico San Carlos, Madrid, Spain. [García García,R, Cordovilla,R] Interventional Pulmonology Unit, Pulmonary Dept, Salamanca University Hospital, Salamanca, Spain. [Núñez-Ares,A] Interventional Pulmonology Unit, Pulmonary Dept, Albacete, Spain. [Briones-Gómez,A, Cases Viedma,E] Interventional Pulmonology Unit, Pulmonary Dept, Hospital Universitario y Politécnico La Fe, Valencia, Spain. [Franco,J] Pneumology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain. [Cosano Povedano,J] Bronchoscopy and Interventional Pulmonology Unit, Pulmonology Dept, Hospital Universitario Reina Sofía, IMIBIC, Córdoba, Spain. [Rodríguez-Perálvarez,ML] Maimónides Institute of Biomedical Research of Córdoba (IMIBIC), CIBERehd, Córdoba, Spain. [Cebrian Gallardo,JJ] Dept of Pulmonology, Agencia sanitaria Costa del Sol, Marbella, Spain. [Nuñez Delgado,M] Dept of Bronchoscopy and Interventional Pulmonology, Hospital Álvaro Cunqueiro, CHUVI, Vigo, Spain. [Pavón-Masa,M] Dept of Interventional Pulmonology, Hospital Universitario Virgen Macarena, Seville, Spain. [Valdivia Salas,MDM] Dept of Interventional Pulmonology, Hospital Universitario Santa Lucía, Cartagena, Spain. [Flandes,J] Bronchoscopy and Interventional Pulmonology Unit, Pulmonology Dept, Hospital Fundación Jimenez Diaz, ISS-FJD, CIBERES, Madrid, Spain., and The present study was funded by the Spanish Society of Pulmonology and Thoracic Surgery: extraordinary grant PII 2020 for research in COVID-19.

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Moco, medicine.medical_treatment, Check Tags::Male [Medical Subject Headings], Broncoscopía, medicine.disease_cause, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Techniques, Respiratory System::Bronchoscopy [Medical Subject Headings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Respiratory Therapy::Respiration, Artificial [Medical Subject Headings], Bronchoscopies, law.invention, Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], 03 medical and health sciences, Hyperaemia, 0302 clinical medicine, Bronchoscopy, law, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Models, Theoretical::Models, Statistical::Logistic Models [Medical Subject Headings], Internal medicine, Neumonía, medicine, 030212 general & internal medicine, Anatomy::Fluids and Secretions::Bodily Secretions::Mucus [Medical Subject Headings], Mechanical ventilation, medicine.diagnostic_test, business.industry, SARS-CoV-2, COVID-19, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Mortality [Medical Subject Headings], Pneumonia, medicine.disease, Intensive care unit, Diseases::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [Medical Subject Headings], Mucus, 030228 respiratory system, Superinfection, Cohort, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis [Medical Subject Headings], Medicine, Original Article, medicine.symptom, business
Abstract

BackgroundThe role of bronchoscopy in coronavirus disease 2019 (COVID-19) is a matter of debate.Patients and methodsThis observational multicentre study aimed to analyse the prognostic impact of bronchoscopic findings in a consecutive cohort of patients with suspected or confirmed COVID-19. Patients were enrolled at 17 hospitals from February to June 2020. Predictors of in-hospital mortality were assessed by multivariate logistic regression.ResultsA total of 1027 bronchoscopies were performed in 515 patients (age 61.5±11.2 years; 73% men), stratified into a clinical suspicion cohort (n=30) and a COVID-19 confirmed cohort (n=485). In the clinical suspicion cohort, the diagnostic yield was 36.7%. In the COVID-19 confirmed cohort, bronchoscopies were predominantly performed in the intensive care unit (n=961; 96.4%) and major indications were: difficult mechanical ventilation (43.7%), mucus plugs (39%) and persistence of radiological infiltrates (23.4%). 147 bronchoscopies were performed to rule out superinfection, and diagnostic yield was 42.9%. There were abnormalities in 91.6% of bronchoscopies, the most frequent being mucus secretions (82.4%), haematic secretions (17.7%), mucus plugs (17.6%), and diffuse mucosal hyperaemia (11.4%). The independent predictors of in-hospital mortality were: older age (OR 1.06; pConclusionBronchoscopy may be indicated in carefully selected patients with COVID-19 to rule out superinfection and solve complications related to mechanical ventilation. The presence of haematic secretions in the distal bronchial tract may be considered a poor prognostic feature in COVID-19.

Published
2021

4. Clinical characteristics and outcomes among hospitalized adults with severe COVID-19 admitted to a tertiary medical center and receiving antiviral, antimalarials, glucocorticoids, or immunomodulation with tocilizumab or cyclosporine: A retrospective observational study (COQUIMA cohort)

Author

Ana Roda-Santacruz, Eva María Martí-Ballesteros, Esther Merino-Lanza, María José Monforte-Gómez, Manuel Recio-Rodríguez, Gabriel Sotres-Fernández, María Correyero-Plaza, Margarita Rodríguez-López, José María Echave-Sustaeta María-Tomé, Elena Almagro-Casado, María Dolores Sánchez-Manzano, Lorena Comeche-Casanova, Margarita Remirez-de-Esparza-Otero, Félix J. La Coma-Lanuza, José Manuel Luque-Pinilla, Pablo Guisado-Vasco, Lucia González-Cortijo, Esteban Javier Malo-Benages, Rocío Diez-Munar, Sofia Valderas-Ortega, Daniel Carnevali-Ruiz, Cristina Andreu-Vázquez, Ruth Barrena-Puertas, Israel Thuissard-Vasallo, and Maria Maravillas Carralón-González

Subjects
medicine.medical_specialty, Acute respiratory insufficiency, Infecciones por coronavirus, 01 natural sciences, Article, 03 medical and health sciences, chemistry.chemical_compound, Hospital, Tratamiento médico, 0302 clinical medicine, Tocilizumab, Interquartile range, Internal medicine, Epidemiology, medicine, 030212 general & internal medicine, 0101 mathematics, Severe COVID-19, lcsh:R5-920, business.industry, SARS-CoV-2 infection, 010102 general mathematics, Hydroxychloroquine, Retrospective cohort study, Odds ratio, General Medicine, Clinical trial, Immunosuppressants, Cyclosporine a, Hyperinflammation state, chemistry, Cohort, lcsh:Medicine (General), business, Virología, medicine.drug
Abstract

Background The COVID-19 outbreak challenges the Spanish health system since March 2020. Some available therapies (antimalarials, antivirals, biological agents) were grounded on clinical case observations or basic science data. The aim of this study is to describe the characteristics and impact of different therapies on clinical outcomes in a cohort of severe COVID-19 patients. Methods In this retrospective, single-center, observational study, we collected sequential data on adult patients admitted to Hospital Universitario Quironsalud Madrid. Eligible patients should have a microbiological (positive test on RT-PCR assay from a nasal swab) or an epidemiological diagnosis of severe COVID-19. Demographic, baseline comorbidities, laboratory data, clinical outcomes, and treatments were compared between survivors and non-survivors. We carried out univariate and multivariate logistic regression models to assess potential risk factors for in-hospital mortality. Findings From March 10th to April 15th, 2020, 607 patients were included. Median age was 69 years [interquartile range, {IQR} 22; 65% male). The most common comorbidities were hypertension (276 [46·94%]), diabetes (95 [16·16%]), chronic cardiac (133 [22·62%]) and respiratory (114 [19·39%]) diseases. 141 patients (23·2%) died. In the multivariate model the risk of death increased with older age (odds ratio, for every year of age, 1·15, [95% CI 1·11 - 1·2]), tocilizumab therapy (2·4, [1·13 - 5·11]), C-reactive protein at admission (1·07, per 10 mg/L, [1·04 - 1·10]), d-dimer > 2·5 μg/mL (1·99, [1·03 - 3·86]), diabetes mellitus (2·61, [1·19 - 5·73]), and the PaO2/FiO2 at admission (0·99, per every 1 mmHg, [0·98 - 0·99]). Among the prescribed therapies (tocilizumab, glucocorticoids, lopinavir/ritonavir, hydroxychloroquine, cyclosporine), only cyclosporine was associated with a significant decrease in mortality (0·24, [0·12 - 0·46]; p

Published
2020
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5. Comorbidity in chronic obstructive pulmonary disease. Related to disease severity?

Author

Jose Echave-Sustaeta, Borja G. Cosío, Juan José Soler-Cataluña, Lorena Comeche Casanova, Xavier Ribera, and Ricardo García-Luján

Subjects
Male, Vital capacity, Multivariate analysis, humanos, Severity of Illness Index, volumen espiratorio forzado, Pulmonary Disease, Chronic Obstructive, Hemoglobins, Risk Factors, Surveys and Questionnaires, Forced Expiratory Volume, Prevalence, Stage (cooking), Lung, mediana edad, Original Research, Aged, 80 and over, COPD, anciano, Smoking, prevalencia, Age Factors, distribución de la ji al cuadrado, General Medicine, Middle Aged, Obstructive lung disease, comorbidity, Female, medicine.medical_specialty, Charlson, Pulmonary disease, International Journal of Chronic Obstructive Pulmonary Disease, Disease severity, hemoglobinas, Internal medicine, medicine, Humans, factores de riesgo, índice de gravedad de la enfermedad, análisis multifactorial, Aged, espirometría, Chi-Square Distribution, business.industry, hábito de fumar, medicine.disease, Comorbidity, Dyspnea, Cross-Sectional Studies, pulmón, Spain, Spirometry, Multivariate Analysis, Physical therapy, business, disnea, estudios transversales
Abstract

Background and objective: Several diseases commonly co-exist with chronic obstructive pulmonary disease (COPD), especially in elderly patients. This study aimed to investigate whether there is an association between COPD severity and the frequency of comorbidities in stable COPD patients. Patients and methods: In this multicenter, cross-sectional study, patients with spirometric diagnosis of COPD attended to by internal medicine departments throughout Spain were consecutively recruited by 225 internal medicine specialists. The severity of airflow obstruction was graded using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and data on demographics, smoking history, comorbidities, and dyspnea were collected. The Charlson comorbidity score was calculated. Results: Eight hundred and sixty-six patients were analyzed: male 93%, mean age 69.8 (standard deviation [SD] 9.7) years and forced vital capacity in 1 second 42.1 (SD 17.7)%. Even, the mean (SD) Charlson score was 2.2 (2.2) for stage I, 2.3 (1.5) for stage II, 2.5 (1.6) for stage III, and 2.7 (1.8) for stage IV (P=0.013 between stage I and IV groups), independent predictors of Charlson score in the multivariate analysis were age, smoking history (pack-years), the hemoglobin level, and dyspnea, but not GOLD stage. Conclusion: COPD patients attended to in internal medicine departments show high scores of comorbidity. However, GOLD stage was not an independent predictor of comorbidity., The authors have no conflicts of interest to disclose in this work. This work was partially funded by Boehringer Ingelheim.

Published
2014

6. Prevalencia de anemia asociada a la enfermedad pulmonar obstructiva crónica. Estudio de las variables asociadas

Author

Irene Albarrán Lozano, Ricardo García Luján, Jose Echave-Sustaeta, Pablo Jesús Alonso González, María Jesús Llorente Alonso, and Lorena Comeche Casanova

Subjects
Pulmonary and Respiratory Medicine, Gynecology, medicine.medical_specialty, business.industry, Enfermedad cardiovascular, Medicine, Aparato respiratorio, business
Abstract

Resumen Introduccion La anemia es una de las manifestaciones extrapulmonares de la enfermedad pulmonar obstructiva cronica (EPOC). Su prevalencia, su fisiopatologia y su repercusion clinica son desconocidas. Los objetivos de nuestro estudio son determinar la prevalencia de la anemia en pacientes con EPOC en fase estable no atribuible a otras causas y establecer la relacion de la anemia con variables clinicas, pronosticas y marcadores inflamatorios con un papel relevante en la EPOC. Metodos Se incluyeron pacientes con EPOC en fase estable sin otras causas conocidas de anemia. Se realizaron pruebas de funcion respiratoria, determinacion de eritropoyetina y marcadores inflamatorios sericos: PCR ultrasensible (PCR), fibrinogeno, interleucina 6 (IL-6), interleucina 8 (IL-8) y factor de necrosis tumoral alfa (TNF-α). Se registro el indice de masa corporal (IMC), el indice de Charlson y el BODE, el numero de exacerbaciones en el ano previo, la escala de disnea y la calidad de vida. Resultados Se incluyeron 130 pacientes. La prevalencia de anemia fue del 6,2%. El valor de hemoglobina en los pacientes con anemia fue de 11,9 ± 0,95 g/dl. Los pacientes con anemia tenian un IMC mas bajo (p = 0,03), un indice de Charlson mayor (p = 0,002), niveles de eritropoyetina mas elevados (p = 0,016), una tendencia a presentar niveles mas bajos de FEV 1 % (p = 0,08) y valores significativamente mas bajos de IL-6 (p = 0,003) cuando se comparan con los pacientes no anemicos. Conclusiones En nuestra serie, la anemia asociada a la EPOC es menos prevalente de lo publicado hasta la actualidad y guarda relacion con determinados factores clinicos y marcadores inflamatorios.

Published
2013

7. Clinical characteristics and outcomes among hospitalized adults with severe COVID-19 admitted to a tertiary medical center and receiving antiviral, antimalarials, glucocorticoids, or immunomodulation with tocilizumab or cyclosporine: A retrospective observational study (COQUIMA cohort)

Author

Pablo Guisado-Vasco, Sofia Valderas-Ortega, Maria Maravillas Carralón-González, Ana Roda-Santacruz, Lucia González-Cortijo, Gabriel Sotres-Fernández, Eva María Martí-Ballesteros, José Manuel Luque-Pinilla, Elena Almagro-Casado, Félix J. La Coma-Lanuza, Ruth Barrena-Puertas, Esteban Javier Malo-Benages, María José Monforte-Gómez, Rocío Diez-Munar, Esther Merino-Lanza, Lorena Comeche-Casanova, Margarita Remirez-de-Esparza-Otero, María Correyero-Plaza, Manuel Recio-Rodríguez, Margarita Rodríguez-López, María Dolores Sánchez-Manzano, Cristina Andreu-Vázquez, Israel John Thuissard-Vasallo, José María Echave-Sustaeta María-Tomé, and Daniel Carnevali-Ruiz

Subjects
Severe COVID-19, SARS-CoV-2 infection, Cyclosporine a, Acute respiratory insufficiency, Immunosuppressants, Hyperinflammation state, Medicine (General), R5-920
Abstract

Background: The COVID-19 outbreak challenges the Spanish health system since March 2020. Some available therapies (antimalarials, antivirals, biological agents) were grounded on clinical case observations or basic science data. The aim of this study is to describe the characteristics and impact of different therapies on clinical outcomes in a cohort of severe COVID-19 patients. Methods: In this retrospective, single-center, observational study, we collected sequential data on adult patients admitted to Hospital Universitario Quironsalud Madrid. Eligible patients should have a microbiological (positive test on RT-PCR assay from a nasal swab) or an epidemiological diagnosis of severe COVID-19. Demographic, baseline comorbidities, laboratory data, clinical outcomes, and treatments were compared between survivors and non-survivors. We carried out univariate and multivariate logistic regression models to assess potential risk factors for in-hospital mortality. Findings: From March 10th to April 15th, 2020, 607 patients were included. Median age was 69 years [interquartile range, {IQR} 22; 65% male). The most common comorbidities were hypertension (276 [46·94%]), diabetes (95 [16·16%]), chronic cardiac (133 [22·62%]) and respiratory (114 [19·39%]) diseases. 141 patients (23·2%) died. In the multivariate model the risk of death increased with older age (odds ratio, for every year of age, 1·15, [95% CI 1·11 - 1·2]), tocilizumab therapy (2·4, [1·13 - 5·11]), C-reactive protein at admission (1·07, per 10 mg/L, [1·04 - 1·10]), d-dimer > 2·5 μg/mL (1·99, [1·03 - 3·86]), diabetes mellitus (2·61, [1·19 - 5·73]), and the PaO2/FiO2 at admission (0·99, per every 1 mmHg, [0·98 - 0·99]). Among the prescribed therapies (tocilizumab, glucocorticoids, lopinavir/ritonavir, hydroxychloroquine, cyclosporine), only cyclosporine was associated with a significant decrease in mortality (0·24, [0·12 - 0·46]; p

Published
2020
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