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1. Clinical and biological markers for predicting ARDS and outcome in septic patients

Author

Jesús Villar, Rubén Herrán-Monge, Elena González-Higueras, Miryam Prieto-González, Alfonso Ambrós, Aurelio Rodríguez-Pérez, Arturo Muriel-Bombín, Rosario Solano, Cristina Cuenca-Rubio, Anxela Vidal, Carlos Flores, Jesús M. González-Martín, M. Isabel García-Laorden, and Genetics of Sepsis (GEN-SEP) Network

Subjects
Medicine, Science
Abstract

Abstract Sepsis is a common cause of acute respiratory distress syndrome (ARDS) associated with a high mortality. A panel of biomarkers (BMs) to identify septic patients at risk for developing ARDS, or at high risk of death, would be of interest for selecting patients for therapeutic trials, which could improve ARDS diagnosis and treatment, and survival chances in sepsis and ARDS. We measured nine protein BMs by ELISA in serum from 232 adult septic patients at diagnosis (152 required invasive mechanical ventilation and 72 had ARDS). A panel including the BMs RAGE, CXCL16 and Ang-2, plus PaO2/FiO2, was good in predicting ARDS (area under the curve = 0.88 in total septic patients). Best performing panels for ICU death are related to the presence of ARDS, need for invasive mechanical ventilation, and pulmonary/extrapulmonary origin of sepsis. In all cases, the use of BMs improved the prediction by clinical markers. Our study confirms the relevance of RAGE, Ang-2, IL-1RA and SP-D, and is novel supporting the inclusion of CXCL16, in BMs panels for predicting ARDS diagnosis and ARDS and sepsis outcome.

Published
2021
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2. Key Factors Associated With Pulmonary Sequelae in the Follow-Up of Critically Ill COVID-19 Patients

Author

Jessica González, Jordi de Batlle, Iván D. Benítez, Gerard Torres, Sally Santisteve, Adriano D.S. Targa, Clara Gort-Paniello, Anna Moncusí-Moix, Maria Aguilà, Fatty Seck, Adrián Ceccato, Ricard Ferrer, Anna Motos, Jordi Riera, Laia Fernández, Rosario Menéndez, José Ángel Lorente, Oscar Peñuelas, Dario Garcia-Gasulla, Yhivian Peñasco, Pilar Ricart, Elena Abril Palomares, Luciano Aguilera, Alejandro Rodríguez, Maria Victoria Boado Varela, Belén Beteré, Juan Carlos Pozo-Laderas, Jordi Solé-Violan, Inmaculada Salvador-Adell, Mariana Andrea Novo, José Barberán, Rosario Amaya Villar, José Garnacho-Montero, José M. Gómez, Aaron Blandino Ortiz, Luis Tamayo Lomas, Alejandro Úbeda, Mercedes Catalán-González, Angel Sánchez-Miralles, Ignacio Martínez Varela, Ruth Noemí Jorge García, Nieves Franco, Víctor D. Gumucio-Sanguino, Elena Bustamante-Munguira, Luis Jorge Valdivia, Jesús Caballero, Elena Gallego, Covadonga Rodríguez, Álvaro Castellanos-Ortega, Josep Trenado, Judith Marin-Corral, Guillermo M. Albaiceta, Maria del Carmen de la Torre, Ana Loza-Vázquez, Pablo Vidal, Jose M. Añón, Cristina Carbajales Pérez, Victor Sagredo, Nieves Carbonell, Lorenzo Socias, Carme Barberà, Angel Estella, Emili Diaz, David de Gonzalo-Calvo, Antoni Torres, Ferran Barbé, María Aguilar Cabello, Victoria Alcaraz-Serrano, Cesar Aldecoa, Cynthia Alegre, Ángela Algaba Calderón, Sergio Álvarez, Antonio Álvarez Ruiz, Ruth Andrea, Maria de Alba Aparicio, Marta Arrieta, J. Ignacio Ayestarán, Joan Ramon Badia, Mariona Badía, Orville Báez Pravia, Ana Balan Mariño, Begoña Balsera, Laura Barbena, Enric Barbeta, Tommaso Bardi, Patricia Barral Segade, Marta Barroso, José Ángel Berezo García, Jesus Bermejo, Judit Bigas, Rafael Blancas, María Luisa Blasco Cortés, María Bodi Saera, Neus Bofill, María Teresa Bouza Vieiro, Leticia Bueno, Juan Bustamante-Munguira, Cecilia del Busto Martínez, David Campi Hermoso, Sandra Campos Fernández, Iosune Cano, Joan Canseco, Pablo Cardinal Fernández, Laura Carrión García, Sulamita Carvalho, Manuel Castellà, Andrea Castellví, Pedro Castro, María José Centelles-Serrano, Ramon Cicuendez Ávila, Catia Cillóniz, Luisa Clar, Cristina Climent, Jordi Codina, Pamela Conde, Sofía Contreras, Raul de Frutos Parra, Raul de Pablo Sánchez, Diego De Mendoza, Yolanda Díaz, María Digna Rivas Vilas, Cristina Dólera Moreno, Irene Dot, Pedro Enríquez Giraudo, Inés Esmorís Arijón, Teresa Farre Monjo, Javier Fernández, Carlos Ferrando, Albert Figueras, Lorena Forcelledo Espina, Enric Franquesa, Àngels Furro, Albert Gabarrus, Cristóbal Galbán, Felipe García, Beatriz García, Emilio García Prieto, Carlos García Redruello, Amaia García Sagastume, Maria Luisa Gascón Castillo, Gemma Gomà, Vanesa Gómez Casal, Silvia Gómez, Carmen Gómez Gonzalez, Federico Gordo, Maria Pilar Gracia, María José Gutierrez Fernández, Alba Herraiz, Rubén Herrán-Monge, Mercedes Ibarz, Silvia Iglesias, Maria Teresa Janer, Gabriel Jiménez, Mar Juan Díaz, Karsa Kiarostami, Juan I. Lazo Álvarez, Miguel León, Alexandre López-Gavín, Desiree Macias Guerrero, Nuria Mamolar Herrera, Rafael Mañez Mendiluce, Cecilia L. Mantellini, Gregorio Marco Naya, Iris Marco Barcos, Pilar Marcos, Enrique Marmol Peis, Marta Martín Cuadrado, María Cruz Martin Delgado, Paula Martín Vicente, María Martínez, Carmen Eulalia Martínez Fernández, Maria Dolores Martínez Juan, Basilisa Martínez Palacios, Juan Fernando Masa Jimenez, Joan Ramon Masclans, Emilio Maseda, Eva María Menor Fernández, Priscila Metora Banderas, Olga Minguez, Mar Miralbés, Josman Monclou, Juan Carlos Montejo-González, Neus Montserrat, María Mora Aznar, Dulce Morales, Sara Guadalupe Moreno Cano, David Mosquera Rodríguez, Rosana Muñoz-Bermúdez, José María Nicolás, Ramon Nogue Bou, Rafaela Nogueras Salinas, Marta Ocón, Ana Ortega, Sergio Ossa, Pablo Pagliarani, Francisco Parrilla, José Pedregosa-Díaz, Leire Pérez Bastida, Purificación Pérez, Felipe Pérez-García, Gloria Pérez Planelles, Eva Pérez Rubio, David Pestaña Laguna, Javier Prados, Andrés Pujol, Núria Ramon Coll, Gloria Renedo Sanchez-Giron, Ferran Roche-Campo, Laura Rodriguez, Felipe Rodríguez de Castro, Silvia Rodríguez, Covadonga Rodríguez Ruiz, Jorge Rubio, Alberto Rubio López, Ángela Leonor Ruiz-García, Miriam Ruiz Miralles, Pablo Ryan Murúa, Eva Saborido Paz, Ana Salazar Degracia, Miguel Sanchez, Ana Sánchez, Susana Sancho Chinesta, Bitor Santacoloma, Maria Teresa Sariñena, Marta Segura Pensado, Lidia Serra, Mireia Serra-Fortuny, Ainhoa Serrano Lázaro, Lluís Servià, Laura Soliva, Carla Speziale, Adrián Tormos, Mateu Torres, Celia Tranque-Liberal, Sandra Trefler, Javier Trujillano, Rafaela Vaca, Estela Val, Luis Valdivia Ruiz, Montserrat Vallverdú, Maria Van der Hofstadt Martin-Montalvo, Sabela Vara Adrio, Nil Vázquez, Javier Vengoechea, Clara Vilà-Vilardel, Judit Vilanova, Tatiana Villada Warrington, Hua Yang, Minlan Yang, and Ana Zapatero

Subjects
Pulmonary and Respiratory Medicine
Published
2023

3. Effect of viral storm in patients admitted to intensive care units with severe COVID-19 in Spain: a multicentre, prospective, cohort study

Author

Jesús F Bermejo-Martin, Nadia García-Mateo, Anna Motos, Salvador Resino, Luis Tamayo, Pablo Ryan Murua, Elena Bustamante-Munguira, Elena Gallego Curto, Alejandro Úbeda-Iglesias, María del Carmen de la Torre, Ángel Estella, Sandra Campos-Fernández, Ignacio Martínez Varela, Felipe Pérez-García, Lorenzo Socias, Juan López Messa, Pablo Vidal-Cortés, Víctor Sagredo Meneses, Milagros González-Rivera, Nieves Carbonell, David de Gonzalo-Calvo, María Cruz Martín Delgado, Luis Jorge Valdivia, Caridad Martín-López, Ruth Noemí Jorge García, Emilio Maseda, Ana Loza-Vázquez, David J Kelvin, Ferrán Barbé, Antoni Torres, Alicia Ortega, Amanda de la Fuente, Raquel Almansa, Tamara Postigo, Noelia Jorge, Ana P Tedim, Laura González-González, Lara Sánchez Recio, Wysali Trapiello, José Ángel Berezo, Rubén Herrán-Monge, Jesús Blanco, Pedro Enríquez, Isidoro Martínez, María Martín-Vicente, María José Muñoz-Gómez, Vicente Más, Mónica Vázquez, Olga Cano, Amalia Martínez de la Gándara, Covadonga Rodríguez, Gloria Andrade, Gloria Renedo, Juan Bustamante-Munguira, Ramón Cicuendez Ávila, María Salgado-Villén, Enrique Berruguilla-Pérez, Estel Güell, Fernando Javier Casadiego Monachello, María Recuerda Núñez, Juan Manuel Sánchez Calvo, Yhivian Peñasco-Martín, María Teresa García Unzueta, Adrián Ceccato, Laia Fernández-Barat, María Teresa Bouza Vieiro, Ana Moreno-Romero, Leire Pérez Bastida, Lorena del Río-Carbajo, Noelia Albalá Martínez, José Manuel Gómez, María Luisa Blasco, Jesús Caballero, Carme Barberà, Jessica González, María Teresa Nieto, Jorge Nieto-del Olmo, Estefanía Prol-Silva, Joan Canseco-Ribas, Jose María Eiros, Instituto de Salud Carlos III, Canadian Institutes of Health Research, Li Ka Shing Foundation, European Society of Clinical Microbiology and Infectious Diseases, Centro de Investigación Biomédica en Red - CIBERES (Enfermedades Respiratorias), Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF), and Unión Europea. Fondo Social Europeo (ESF/FSE)

Subjects
Microbiology (medical), Infectious Diseases, Spain, Virology, COVID-19, Microbiology
Abstract

Background: The contribution of the virus to the pathogenesis of severe COVID-19 is still unclear. We aimed to evaluate associations between viral RNA load in plasma and host response, complications, and deaths in critically ill patients with COVID-19. Methods: We did a prospective cohort study across 23 hospitals in Spain. We included patients aged 18 years or older with laboratory-confirmed SARS-CoV-2 infection who were admitted to an intensive care unit between March 16, 2020, and Feb 27, 2021. RNA of the SARS-CoV-2 nucleocapsid region 1 (N1) was quantified in plasma samples collected from patients in the first 48 h following admission, using digital PCR. Patients were grouped on the basis of N1 quantity: VIR-N1-Zero (2747 N1 copies per mL). The primary outcome was all-cause death within 90 days after admission. We evaluated odds ratios (ORs) for the primary outcome between groups using a logistic regression analysis. Findings: 1068 patients met the inclusion criteria, of whom 117 had insufficient plasma samples and 115 had key information missing. 836 patients were included in the analysis, of whom 403 (48%) were in the VIR-N1-Low group, 283 (34%) were in the VIR-N1-Storm group, and 150 (18%) were in the VIR-N1-Zero group. Overall, patients in the VIR-N1-Storm group had the most severe disease: 266 (94%) of 283 patients received invasive mechanical ventilation (IMV), 116 (41%) developed acute kidney injury, 180 (65%) had secondary infections, and 148 (52%) died within 90 days. Patients in the VIR-N1-Zero group had the least severe disease: 81 (54%) of 150 received IMV, 34 (23%) developed acute kidney injury, 47 (32%) had secondary infections, and 26 (17%) died within 90 days (OR for death 0·30, 95% CI 0·16-0·55; p

Published
2023

4. Remdesivir and survival outcomes in critically ill patients with COVID-19: A multicentre observational cohort study

Author

Catia Cillóniz, Anna Motos, Tatiana Castañeda, Albert Gabarrús, Ferran Barbé, Antoni Torres, Víctor D. Gumucio-Sanguino, Rafael Mañez, Jordi Solé-Violan, Felipe Rodríguez de Castro, Fernando Suarez-Sipmann, Ruth Noemí Jorge García, María Mora Aznar, Mateu Torres, María Martinez, Cynthia Alegre, Jordi Riera, Sofía Contreras, Juan Manuel Pericas, Ricard Ferrer, Jesús Caballero, Javier Trujillano, Montse Vallverdú, Miguel León, Mariona Badía, Begoña Balsera, Lluís Servià, Judit Vilanova, Silvia Rodríguez, Neus Montserrat, Silvia Iglesias, Javier Prados, Sula Carvalho, Mar Miralbés, Josman Monclou, Gabriel Jiménez, Jordi Codina, Estela Val, Pablo Pagliarani, Jorge Rubio, Dulce Morales, Andrés Pujol, Àngels Furro, Beatriz García, Gerard Torres, Javier Vengoechea, David de Gonzalo-Calvo, Jessica González, Silvia Gomez, José M. Gómez, Nieves Franco, José Barberán, Guillermo M Albaiceta, Lorena Forcelledo Espina, Emilio García Prieto, Paula Martín Vicente, Cecilia del Busto Martínez, Pablo Vidal-Cortés, José Luis García Garmendia, María Aguilar Cabello, Carmen Eulalia Martínez Fernández, Nieves Carbonell, María Luisa Blasco Cortés, Ainhoa Serrano Lázaro, Mar Juan Díaz, Aaron Blandino Ortiz, Rosario Menendez, Luis Jorge Valdivia, María Victoria Boado, Susana Sancho Chinesta, Maria del Carmen de la Torre, Ignacio Martínez Varela, María Teresa Bouza Vieiro, Inés Esmorís Arijón, David Campi Hermoso, Rafaela Nogueras Salinas, Teresa Farre Monjo, Ramon Nogue Bou, Gregorio Marco Naya, Carme Barberà, Núria Ramon Coll, Mercedes Catalán-González, Juan Carlos Montejo-González, Gloria Renedo Sanchez-Giron, Juan Bustamante-Munguira, Elena Bustamante-Munguira, Ramon Cicuendez Avila, Nuria Mamolar Herrera, Raquel Almansa, Alicia Ortega, Jesús Bermejo-Martin, Víctor Sagredo, Jose Añon, Alexander Agrifoglio, Lucia Cachafeiro, Emilio Maseda, Lorenzo Socias, Mariana Andrea Novo, Albert Figueras, Maria Teresa Janer, Laura Soliva, Marta Ocón, Luisa Clar, J Ignacio Ayestarán, Yhivian Peñasco, Sandra Campos Fernández, Mireia Serra-Fortuny, Eva Forcadell-Ferreres, Immaculada Salvador-Adell, Neus Bofill, Berta Adell-Serrano, Josep Pedregosa Díaz, Núria Casacuberta-Barberà, Luis Urrelo-Cerrón, Àngels Piñol-Tena, Ferran Roche-Campo, Amalia Martínez de la Gándara, Pablo Ryan Murúa, Covadonga Rodríguez Ruíz, Laura Carrión García, Juan I Lazo Álvarez, José Ángel Lorente, Ana Loza-Vázquez, Desire Macias Guerrero, Arturo Huerta, Daniel Tognetti, Carlos García Redruello, David Mosquera Rodríguez, Eva María Menor Fernández, Sabela Vara Adrio, Vanesa Gómez Casal, Marta Segura Pensado, María Digna Rivas Vilas, Amaia García Sagastume, Raul de Pablo Sánchez, David Pestaña Laguna, Tommaso Bardi, Rosario Amaya Villar, Carmen Gómez Gonzalez, Maria Luisa Gascón Castillo, José Garnacho-Montero, María Luisa Cantón-Bulnes, Judith Marin-Corral, Cristina Carbajales Pérez, Joan Ramon Masclans, Ana Salazar Degracia, Judit Bigas, Rosana Muñoz-Bermúdez, Clara Vilà-Vilardel, Francisco Parrilla, Irene Dot, Ana Zapatero, Yolanda Díaz, María Pilar Gracia, Purificación Pérez, Andrea Castellví, Cristina Climent, Lidia Serra, Laura Barbena, Iosune Cano, Pilar Ricart, Alba Herraiz, Pilar Marcos, Laura Rodríguez, Maria Teresa Sariñena, Ana Sánchez, Alejandro Úbeda, María Cruz Martin Delgado, Elena Gallego, Juan Fernando Masa Jimenez, Gemma Gomà, Emi Díaz, Mercedes Ibarz, Diego De Mendoza, Enric Barbeta, Victoria Alcaraz-Serrano, Joan Ramon Badia, Manuel Castella, Leticia Bueno, Adrian Ceccato, Andrea Palomeque, Laia Fernandez Barat, Pamela Conde, Javier Fernández, Albert Gabarrus, Karsa Kiarostami, Alexandre López-Gavín, Cecilia L Mantellini, Carla Speziale, Nil Vázquez, Hua Yang, Minlan Yang, Carlos Ferrando, Pedro Castro, Marta Arrieta, Jose Maria Nicolas, Rut Andrea, Marta Barroso, Raquel Pérez, Sergio Álvarez, Dario Garcia-Gasulla, Adrián Tormos, Luis Tamayo Lomas, Cesar Aldecoa, Rubén Herrán-Monge, José Ángel Berezo García, Pedro Enríquez Giraudo, Pablo Cardinal Fernández, Alberto Rubio López, Orville Báez Pravia, Juan López Messa, Leire Pérez Bastida, Antonjo Alvarez Ruiz, José Trenado, Anna Parera Pous, Cristóbal Galbán, Ana López Lago, Eva Saborido Paz, Patricia Barral Segade, Ana Balan Mariño, Manuel Valledor Mendez, Raúl de Frutos, Luciano Aguilera, Felipe Pérez-García, Esther López-Ramos, Ángela Leonor Ruiz-García, Belén Beteré, Rafael Blancas, Cristina Dólera, Gloria Perez Planelles, Enrique Marmol Peis, Maria Dolores Martinez Juan, Miriam Ruiz Miralles, Eva Perez Rubio, Maria Van der Hofstadt Martin-Montalvo, Ángel Sánchez-Miralles, Tatiana Villada Warrington, Juan Carlos Pozo-Laderas, Angel Estrella, Sara Guadalupe Moreno Cano, Federico Gordo, Basilisa Martinez Palacios, Maite Nieto, Maria Teresa Nieto, Sergio Ossa, Ana Ortega, Miguel Sanchez, and Bitor Santacoloma

Subjects
Microbiology (medical), Infectious Diseases
Published
2022

5. Low anti‐SARS‐CoV‐2 S antibody levels predict increased mortality and dissemination of viral components in the blood of critical COVID‐19 patients

Author

Rubén Herrán-Monge, Wysali Trapiello, Laia Fernández-Barat, Cristina Doncel, Milagros González-Rivera, Carolina Puertas, Marta Domínguez-Gil, Jesus F. Bermejo-Martin, María José Muñoz-Gómez, Elena Bustamante, Felipe Pérez-García, Ana P. Tedim, Pedro Enriquez, Isidoro Martínez, Jesús Rico-Feijoo, David J. Kelvin, Vicente Mas, María Martín-Vicente, Noelia Jorge, P. Olivares, José María Eiros, Raquel Almansa, Mónica Herrero Vázquez, Antoni Torres, Ferran Barbé, Cesar Aldecoa, Anna Motos, José Manuel Gómez, Gloria Renedo, Jose Ángel Berezo, Amanda de la Fuente, Salvador Resino, Alicia Ortega, Nuria Mamolar, Ramón Cicuendez, Juan Bustamante-Munguira, Jamil Antonio Cedeno, Silvia Martín, Luis Tamayo, and Ricard Ferrer

Subjects
Coronavirus disease 2019 (COVID-19), Critical Illness, viruses, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Antibodies, Viral, 03 medical and health sciences, 0302 clinical medicine, COVID‐19, S Antibody, antigenaemia, Internal Medicine, Humans, antibodies, Medicine, 030212 general & internal medicine, Antigens, Viral, 030304 developmental biology, 0303 health sciences, Viral Components, biology, SARS-CoV-2, Critically ill, business.industry, Brief Report, COVID-19, mortality, 3. Good health, Icu admission, Viral replication, Immunology, biology.protein, RNA, Viral, RNA, Brief Reports, Antibody, business
Abstract

Background Anti‐SARS‐CoV‐2 S antibodies prevent viral replication. Critically ill COVID‐19 patients show viral material in plasma, associated with a dysregulated host response. If these antibodies influence survival and viral dissemination in ICU‐COVID patients is unknown. Patients/Methods We studied the impact of anti‐SARS‐CoV‐2 S antibodies levels on survival, viral RNA‐load in plasma, and N‐antigenaemia in 92 COVID‐19 patients over ICU admission. Results Frequency of N‐antigenaemia was >2.5‐fold higher in absence of antibodies. Antibodies correlated inversely with viral RNA‐load in plasma, representing a protective factor against mortality (Adjusted HR [CI 95%], p): (S IgM [AUC ≥ 60]: 0.44 [0.22; 0.88], 0.020); (S IgG [AUC ≥ 237]: 0.31 [0.16; 0.61]

Published
2021

6. The protective association of endogenous immunoglobulins against sepsis mortality is restricted to patients with moderate organ failure

Author

Adriele Prina-Mello, Eduardo Anton, Jesús Blanco, Rubén Herrán-Monge, Ana Rodriguez-Fernandez, Ignacio Martin-Loeches, Wysali Trapiello, Jordi Solé-Violán, Antonio Artigas, David Andaluz-Ojeda, Arturo Muriel-Bombín, Ana Loza, B. Suberviola, Jesus F. Bermejo-Martin, Pedro Merino, Ricard Ferrer, Leonardo Lorente, Pablo Garcia-Olivares, Eduardo Tamayo, Institut Català de la Salut, [Martin-Loeches I] Multidisciplinary Intensive Care Research Organization (MICRO), St. James’s University Hospitals Dublin, James’s St, Ushers, Dublin 8, Ireland. [Muriel-Bombín A] Intensive Care Department, Hospital Universitario Río Hortega de Valladolid, Calle Dulzaina, 2, 47012 Valladolid, Spain. [Ferrer R] Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Grup de Shock, Disfunció Orgànica i Ressucitació, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. ABISS Edusepsis (AntiBiotic Intervention in Severe Sepsis), Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Artigas A] ABISS Edusepsis (AntiBiotic Intervention in Severe Sepsis), Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Critical Care Center, Corporacion Sanitaria Universitaria Parc Tauli, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Barcelona, Spain. CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, C/Sinesio Delgado,4, 28029 Madrid, Spain. [Sole-Violan J] ABISS Edusepsis (AntiBiotic Intervention in Severe Sepsis), Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Critical Care Medicine Service, Hospital Dr Negrin, Barranco de la Ballena, s/n, 35010 Las Palmas de Gran Canaria, Las Palmas, Spain. [Lorente L] ABISS Edusepsis (AntiBiotic Intervention in Severe Sepsis), Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Critical Care Medicine Service, Hospital Universitario de Canarias, Carretera de Ofra, s/n, 38320 San Cristóbal de La Laguna, Santa Cruz De Tenerife, Spain. [Suberviola B] ABISS Edusepsis (AntiBiotic Intervention in Severe Sepsis), Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Critical Care Medicine Service, Hospital Universitario Marqués de Valdecilla, Av. Valdecilla, 25, 39008 Santander, Spain. [Loza AM] ABISS Edusepsis (AntiBiotic Intervention in Severe Sepsis), Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Critical Care Medicine Service, Hospital Nuestra Señora de Valme, Av. de Bellavista, s/n, 41014 Seville, Spain. [Garcia-Olivares P] ABISS Edusepsis (AntiBiotic Intervention in Severe Sepsis), Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Critical Care Medicine Service, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007 Madrid, Spain. [Anton E] ABISS Edusepsis (AntiBiotic Intervention in Severe Sepsis), Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Critical Care Medicine Service, Hospital de Manacor, Carretera Manacor Alcudia, s/n, 07500 Manacor, Spain, and Vall d'Hebron Barcelona Hospital Campus

Subjects
medicine.medical_specialty, Immunoglobulin levels, Survival, Sepsis mortality, medicine.medical_treatment, health care facilities, manpower, and services, Immunoglobulins, Endogeny, infecciones bacterianas y micosis::infección::sepsis [ENFERMEDADES], Disease, Critical Care and Intensive Care Medicine, Logistic regression, Severity, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Other subheadings::Other subheadings::Other subheadings::/mortality [Other subheadings], Internal medicine, Anesthesiology, Medicine, 030212 general & internal medicine, aminoácidos, péptidos y proteínas::proteínas::proteínas sanguíneas::inmunoproteínas::inmunoglobulinas [COMPUESTOS QUÍMICOS Y DROGAS], Septicèmia - Mortalitat, Amino Acids, Peptides, and Proteins::Proteins::Blood Proteins::Immunoproteins::Immunoglobulins [CHEMICALS AND DRUGS], Otros calificadores::Otros calificadores::Otros calificadores::/mortalidad [Otros calificadores], biology, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, Immunosuppression, Retrospective cohort study, lcsh:RC86-88.9, medicine.disease, Surgery, Intravenous Immunoglobulins, biology.protein, Bacterial Infections and Mycoses::Infection::Sepsis [DISEASES], Antibody, Immunoglobulines, business
Abstract

Background: Pre-evaluation of endogenous immunoglobulin levels is a potential strategy to improve the results of intravenous immunoglobulins in sepsis, but more work has to be done to identify those patients who could benefit the most from this treatment. The objective of this study was to evaluate the impact of endogenous immunoglobulins on the mortality risk in sepsis depending on disease severity. Methods: This was a retrospective observational study including 278 patients admitted to the ICU with sepsis fulfilling the SEPSIS-3 criteria, coming from the Spanish GRECIA and ABISS-EDUSEPSIS cohorts. Patients were distributed into two groups depending on their Sequential Organ Failure Assessment score at ICU admission (SOFA < 8, n = 122 and SOFA >= 8, n = 156), and the association between immunoglobulin levels at ICU admission with mortality was studied in each group by Kaplan-Meier and multivariate logistic regression analysis. Results: ICU/hospital mortality in the SOFA < 8 group was 14.8/23.0%, compared to 30.1/35.3% in the SOFA >= 8 group. In the group with SOFA < 8, the simultaneous presence of total IgG < 407 mg/dl, IgM < 43 mg/dl and IgA < 219 mg/dl was associated with a reduction in the survival mean time of 6.6 days in the first 28 days and was a robust predictor of mortality risk either during the acute or during the post-acute phase of the disease (OR for ICU mortality: 13.79; OR for hospital mortality: 7.98). This predictive ability remained in the absence of prior immunosuppression (OR for ICU mortality: 17.53; OR for hospital mortality: 5.63). Total IgG < 407 mg/dl or IgG1 < 332 mg/dl was also an independent predictor of ICU mortality in this group. In contrast, in the SOFA >= 8 group, we found no immunoglobulin thresholds associated with neither ICU nor hospital mortality. Conclusions: Endogenous immunoglobulin levels may have a different impact on the mortality risk of sepsis patients based on their severity. In patients with moderate organ failure, the simultaneous presence of low levels of IgG, IgA and IgM was a consistent predictor of both acute and post-acute mortalities., The GRECIA study was supported by Proyectos de Investigacion en Biomedicina, Consejeria de Sanidad, JCYL (Grant Code BOCYL-D-26072010). The authors thank also Instituto de Salud Carlos III for their financial support (Grant Code EMER 07/050, ISCIII-FIS-PI12-01815). The funding agencies were not involved neither in the design of the study and collection, nor in the analysis, interpretation of data or manuscript writing.

Published
2017

7. Age-related injury patterns in Spanish trauma ICU patients. Results from the RETRAUCI

Author

Lucía López-Amor, J. González-Robledo, Fermín Alberdi-Odriozola, Rubén Herrán-Monge, M. Chico-Fernández, María Dolores Mayor-García, F. Guerrero-López, M.Á. Ballesteros-Sanz, J.A. Llompart-Pou, A. Bueno-González, M. Sánchez-Casado, and Rafael León-López

Subjects
Adult, Male, Aging, medicine.medical_specialty, Poison control, Comorbidity, law.invention, 03 medical and health sciences, Age Distribution, Injury Severity Score, 0302 clinical medicine, Trauma Centers, Interquartile range, law, Internal medicine, Epidemiology, Injury prevention, Humans, Medicine, Hospital Mortality, Prospective Studies, 030212 general & internal medicine, Young adult, Aged, General Environmental Science, Multiple Trauma, business.industry, Age Factors, Anticoagulants, 030208 emergency & critical care medicine, Acute Kidney Injury, Middle Aged, Intensive care unit, Intensive Care Units, Spain, Blunt trauma, Emergency medicine, General Earth and Planetary Sciences, Female, Intracranial Hypertension, business
Abstract

Background Injury patterns may differ in trauma patients when age is considered. This information is relevant in the management of trauma patients and for planning preventive measures. Methods We included in the study all patients admitted for traumatic disease in the participating ICUs from November 23rd, 2012 to July 31st, 2015 with complete records. Data on epidemiology, injury patterns, severity scores, acute management, resources utilisation and outcome were recorded and compared in the following groups of age: ≤ 55 years (young adults), 56–65 years (adults), 66–75 years (elderly), > 75 years (very elderly). Quantitative data were reported as median (Interquartile Range (IQR) 25–75) and categorical data as number and percentage. Comparison between groups of age with quantitative variables was performed using the analysis of variance (ANOVA) test. Differences between groups with categorical variables were compared using the chi-square test. A value of p Results We included 2700 patients (78.9% male). Median age was 46 (31–62) years. Blunt trauma was present in 93.7% of the patients. Median RTS was 7.55 (5.97–7.84). Median ISS was 20 (13–26). High-energy trauma secondary to motor-vehicle accident with rhabdomyolysis and drugs abuse showed an inverse linear association with ageing, whilst pedestrian falls with isolated brain injury, being run-over and pre-injury antiplatelets or anticoagulant treatment increased with age (in all cases p Conclusions Different injury patterns exist in relation with ageing in trauma ICU patients. Adult patients were more likely to present high-energy trauma with significant injuries in different areas whilst elderly patients were prone to low-energy falls, complicated by antiplatelets or anticoagulants use, resulting in severe brain injury and increased mortality.

Published
2016

8. Scoring severity in trauma: comparison of prehospital scoring systems in trauma ICU patients

Author

J. González-Robledo, C. Carbayo-Górriz, R. León-López, Mario Chico-Fernández, M. Sánchez-Casado, L. Servià-Goixart, M.Á. Ballesteros-Sanz, F. Guerrero-López, E. Val-Jordán, Juan Antonio Llompart-Pou, R. Salaberria-Udabe, and Rubén Herrán-Monge

Subjects
Adult, Male, medicine.medical_specialty, Poison control, Critical Care and Intensive Care Medicine, Sensitivity and Specificity, 03 medical and health sciences, Injury Severity Score, 0302 clinical medicine, Interquartile range, Internal medicine, medicine, Chi-square test, Humans, Orthopedics and Sports Medicine, Prospective Studies, Registries, 030212 general & internal medicine, Multiple Trauma, business.industry, Glasgow Coma Scale, Area under the curve, 030208 emergency & critical care medicine, Middle Aged, Confidence interval, Surgery, Benchmarking, Intensive Care Units, Blood pressure, ROC Curve, Spain, Area Under Curve, Emergency Medicine, Female, Triage, Emergency Service, Hospital, business
Abstract

We evaluated the predictive ability of mechanism, Glasgow coma scale, age and arterial pressure (MGAP), Glasgow coma scale, age and systolic blood pressure (GAP), and triage-revised trauma Score (T-RTS) scores in patients from the Spanish trauma ICU registry using the trauma and injury severity score (TRISS) as a reference standard. Patients admitted for traumatic disease in the participating ICU were included. Quantitative data were reported as median [interquartile range (IQR), categorical data as number (percentage)]. Comparisons between groups with quantitative variables and categorical variables were performed using Student’s T Test and Chi Square Test, respectively. We performed receiving operating curves (ROC) and evaluated the area under the curve (AUC) with its 95 % confidence interval (CI). Sensitivity, specificity, positive predictive and negative predictive values and accuracy were evaluated in all the scores. A value of p

Published
2016

9. Epidemiology and Changes in Mortality of Sepsis After the Implementation of Surviving Sepsis Campaign Guidelines

Author

Ana M. Domínguez-Berrot, Arturo Muriel-Bombín, Jesús Blanco, M. José Fernández-Calavia, Pedro A. Merino-García, Santiago Macías, Miguel Martínez-Barrios, Rubén Herrán-Monge, Concepción Tarancón, Braulio Álvarez-Martínez, Susana Moradillo-Gonzalez, Marta M. García-García, Juan Carlos Ballesteros, Jesús Villar, and David Andaluz

Subjects
Male, medicine.medical_specialty, Surviving Sepsis Campaign, Critical Care, Organ Dysfunction Scores, Critical Care and Intensive Care Medicine, Risk Assessment, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Early Medical Intervention, Epidemiology, medicine, Prevalence, Humans, Mortality prediction, Hospital Mortality, Intensive care medicine, Severe sepsis, APACHE, Aged, Septic shock, business.industry, Incidence, Age Factors, 030208 emergency & critical care medicine, Middle Aged, medicine.disease, Quality Improvement, Shock, Septic, 030228 respiratory system, Spain, Practice Guidelines as Topic, Intraabdominal Infections, Female, business
Abstract

Purpose: To determine the epidemiology and outcome of severe sepsis and septic shock after 9 years of the implementation of the Surviving Sepsis Campaign (SSC) and to build a mortality prediction model. Methods: This is a prospective, multicenter, observational study performed during a 5-month period in 2011 in a network of 11 intensive care units (ICUs). We compared our findings with those obtained in the same ICUs in a study conducted in 2002. Results: The current cohort included 262 episodes of severe sepsis and/or septic shock, and the 2002 cohort included 324. The prevalence was 14% (95% confidence interval: 12.5-15.7) with no differences to 2002. The population-based incidence was 31 cases/100 000 inhabitants/year. Patients in 2011 had a significantly lower Acute Physiology and Chronic Health Evaluation II (APACHE II; 21.9 ± 6.6 vs 25.5 ± 7.07), Logistic Organ Dysfunction Score (5.6 ± 3.2 vs 6.3 ± 3.6), and Sequential Organ Failure Assessment (SOFA) scores on day 1 (8 ± 3.5 vs 9.6 ± 3.7; P < .01). The main source of infection was intraabdominal (32.5%) although microbiologic isolation was possible in 56.7% of cases. The 2011 cohort had a marked reduction in 48-hour (7% vs 14.8%), ICU (27.2% vs 48.2%), and in-hospital (36.7% vs 54.3%) mortalities. Most relevant factors associated with death were APACHE II score, age, previous immunosuppression and liver insufficiency, alcoholism, nosocomial infection, and Delta SOFA score. Conclusion: Although the incidence of sepsis/septic shock remained unchanged during a 10-year period, the implementation of the SSC guidelines resulted in a marked decrease in the overall mortality. The lower severity of patients on ICU admission and the reduced early mortality suggest an improvement in early diagnosis, better initial management, and earlier antibiotic treatment.

Published
2017

10. Immunoglobulins IgG1, IgM and IgA: a synergistic team influencing survival in sepsis

Author

Raquel Almansa, Arturo Muriel-Bombín, Ana Rodriguez-Fernandez, Pedro Merino, David Andaluz-Ojeda, Jesús Blanco, M M García-García, Jesus F. Bermejo-Martin, Francisco Gandía, R Citores, and Rubén Herrán-Monge

Subjects
Male, Immunoglobulin A, medicine.medical_specialty, Kaplan-Meier Estimate, Gastroenterology, law.invention, Sepsis, Immunocompromised Host, law, Internal medicine, Internal Medicine, medicine, Humans, Prospective Studies, Risk factor, Prospective cohort study, Aged, biology, Septic shock, business.industry, Odds ratio, Prognosis, medicine.disease, Shock, Septic, Intensive care unit, Intensive Care Units, Immunoglobulin M, Immunoglobulin G, Immunology, biology.protein, Regression Analysis, Female, business
Abstract

Objective The impact of endogenous immunoglobulin isotypes on the prognosis of patients with severe sepsis has not been sufficiently explored. The aim of this study was to evaluate the association between immunoglobulin levels in plasma and survival in patients with this condition. Design and patients A prospective multicentre cohort study was conducted. A total of 172 adult patients admitted to the intensive care unit (ICU) with severe sepsis or septic shock were recruited. Patients were classified based on deciles of immunoglobulin concentrations at diagnosis of sepsis. Categorical variables were created and tested for their association with survival during hospitalization in the ICU. Results Overall, 42 patients died in the ICU during the study. Kaplan–Meier analysis showed that immunoglobulin concentrations below 300 mg dL−1 for IgG1, 35 mg dL−1 for IgM and 150 mg dL−1 for IgA were associated with shorter survival times. Multivariate regression analysis showed that IgG1 < 300 mg dL−1 was a risk factor for mortality [odds ratio (OR) 2.50, 95% confidence interval (CI) 1.04–6.03; P = 0.042]. The combined presence of IgG1, IgM and IgA levels below the described thresholds had a synergistic impact on mortality risk (OR 5.27, 95% CI 1.41–19.69; P = 0.013). A similar effect was observed for combined low levels of IgG1 and IgA (OR 4.10, 95% CI 1.28–13.12; P = 0.018) and also of IgG1 and IgM (OR 3.10. 95% CI 1.13–8.49; P = 0.028). Conclusions The combined presence of low levels of the endogenous immunoglobulins IgG1, IgM and IgA in plasma is associated with reduced survival in patients with severe sepsis or septic shock. Assessment of the concentrations of these immunoglobulins could improve the results of treatment with exogenous immunoglobulins in patients with sepsis.

Published
2014

11. A randomized trial of intravenous glutamine supplementation in trauma ICU patients

Author

Ignacio Ayestarán, Antonio Oliver, Arturo Zabalegui-Pérez, Esther Corral, Joan Maria Raurich, Rubén Herrán-Monge, María Gero-Escapa, Juan Antonio Llompart-Pou, Mercedes Cervera, Guiem Frontera, Pedro Marsé, Jon Pérez-Bárcena, Antonio Buño, and Abelardo García de Lorenzo

Subjects
medicine.medical_specialty, Trauma ICU, business.industry, Critical Care and Intensive Care Medicine, Intensive care unit, law.invention, Surgery, Multicenter study, Randomized controlled trial, law, Anesthesiology, Anesthesia, Glutamine supplementation, Medicine, business, Prospective cohort study
Abstract

Purpose To evaluate the effect of the intravenous (i.v.) l-alanyl-l-glutamine dipeptide supplementation during 5 days on clinical outcome in trauma patients admitted to the intensive care unit (ICU).

Published
2014

12. Mortality Reduction and Long-Term Compliance with Surviving Sepsis Campaign: A Nationwide Multicenter Study

Author

Braulio Álvarez-Martínez, José A. Fernández-Ratero, Jesús Villar, Arturo Muriel-Bombín, Rubén Herrán-Monge, Susana Moradillo-Gonzalez, Marta M. García-García, Rafael Cítores-González, Pedro A. Merino-García, Jesús María Blanco, Concepción Tarancón, Noelia Albalá, Demetrio Carriedo, Santiago Macías, and María J. Fernández Calavia

Subjects
Male, medicine.medical_specialty, Resuscitation, Canada, Surviving Sepsis Campaign, Critical Care and Intensive Care Medicine, Severity of Illness Index, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Intensive care, Severity of illness, medicine, Humans, 030212 general & internal medicine, Hospital Mortality, Prospective Studies, Intensive care medicine, Prospective cohort study, Aged, Aged, 80 and over, business.industry, 030208 emergency & critical care medicine, Middle Aged, medicine.disease, Shock, Septic, Intensive Care Units, Spain, Cohort, Emergency medicine, Practice Guidelines as Topic, Emergency Medicine, Patient Compliance, Female, Guideline Adherence, business, Historical Cohort
Abstract

PURPOSE To determine the long-term degree of compliance with the Surviving Sepsis Campaign (SSC) bundles and related outcomes after an educational program in septic patients admitted to a network of intensive care units (ICU). METHODS Prospective, observational, multicenter study in several ICUs during a 5-month period for evaluating the degree of compliance with the SSC bundles of resuscitation in the first 6 h (B6H) and management in the following 24 h (B24H). We compared the findings with those from a historical cohort at the same ICUs after an educational program (EDUSEPSIS) 5 years earlier. RESULTS The study cohort comprised 231 episodes of severe sepsis and the historical cohort included 217. In the current cohort, we found a better compliance with B6H compared with the historical cohort (27.7% vs. 9.7%, P

Published
2016

13. Sobredosis letal accidental de colchicina

Author

Arturo Muriel-Bombín, M M García-García, M.L. Fernández-Rodríguez, Rubén Herrán-Monge, A.M. Prieto de Lamo, and A. Dueñas-Laita

Subjects
Traditional medicine, business.industry, Medicine, Critical Care and Intensive Care Medicine, business
Published
2013

14. Circulating neutrophil counts and mortality in septic shock

Author

Jesús F, Bermejo-Martín, Eduardo, Tamayo, Gema, Ruiz, David, Andaluz-Ojeda, Rubén, Herrán-Monge, Arturo, Muriel-Bombín, Maria, Fe Muñoz, María, Heredia-Rodríguez, Rafael, Citores, José, Gómez-Herreras, Jesús, Blanco, and Priscila, Carcelen

Subjects
Male, medicine.medical_specialty, Letter, Neutrophils, Critical Illness, Endothelial damage, Context (language use), Kaplan-Meier Estimate, Critical Care and Intensive Care Medicine, Validation cohort, Sepsis, Cohort Studies, Leukocyte Count, Internal medicine, Septic shock, medicine, Humans, Cohorte de validación, Survival analysis, Aged, Aged, 80 and over, Proportional hazards model, business.industry, medicine.disease, Prognosis, Shock, Septic, Choque séptico, Immunology, Cohort, Absolute neutrophil count, Female, business, Biomarkers, Cohort study, Daño endotelial
Abstract

Producción Científica, Polynuclear neutrophils can play dual roles in sepsis: on the one hand they mediate major antimicrobial activities and on the other hand they can contribute to the development of multiple organ failure [1]. Nonetheless, in spite of the importance of these cells in sepsis, the influence of the circulating neutrophil count (CNC) on the prognosis of septic patients with this pathology has not been properly evaluated. We analyzed the association between CNC and outcome in two cohorts of patients with diagnostic criteria of septic shock (SS) [2]: the first was recruited in the context of a single center study (EXPRESS study, discovery cohort, n = 195; Table 1), and the second in the context of a multi-centric study (GRECIA study, validation cohort, n = 194; Table 2). Written informed consent was obtained from each patient or their legal representative. The two studies were approved by the Research Ethics Committee of the Hospital Clínico Universitario, Valladolid, Spain (for the EXPRESS study) and Hospital Universitario Río Hortega, Valladolid, Spain (coordinating center for the GRECIA study)., Instituto de Salud Carlos III (grant PI 10/01362), Junta de Castilla y León (grant BOCYL-D-26072010)

Published
2014

15. The protective association of endogenous immunoglobulins against sepsis mortality is restricted to patients with moderate organ failure

Author

Ignacio Martin-Loeches, Arturo Muriel-Bombín, Ricard Ferrer, Antonio Artigas, Jordi Sole-Violan, Leonardo Lorente, David Andaluz-Ojeda, Adriele Prina-Mello, Ruben Herrán-Monge, Borja Suberviola, Ana Rodriguez-Fernandez, Pedro Merino, Ana M. Loza, Pablo Garcia-Olivares, Eduardo Anton, Eduardo Tamayo, Wysali Trapiello, Jesús Blanco, Jesús F. Bermejo-Martin, and the GRECIA group

Subjects
Immunoglobulins, Sepsis, Severity, Survival, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Pre-evaluation of endogenous immunoglobulin levels is a potential strategy to improve the results of intravenous immunoglobulins in sepsis, but more work has to be done to identify those patients who could benefit the most from this treatment. The objective of this study was to evaluate the impact of endogenous immunoglobulins on the mortality risk in sepsis depending on disease severity. Methods This was a retrospective observational study including 278 patients admitted to the ICU with sepsis fulfilling the SEPSIS-3 criteria, coming from the Spanish GRECIA and ABISS-EDUSEPSIS cohorts. Patients were distributed into two groups depending on their Sequential Organ Failure Assessment score at ICU admission (SOFA

Published
2017
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