Valoración del paciente geriátrico en el servicio de medicina interna

Introduction: The increase in the population of the elderly, added to the increase in pluripatology and polypharmacy, makes their admission to hospitals more and more frequent. Objectives: To establish the profile of the geriatric patient older than 75 years, with pluripatology and treated in the Internal Medicine Unit of the Virgen de la Concha Hospital. Analyze the results of the functional assessment through the Barthel scale. Identify the social situation through the Gijón scale. Methods: Retrospective observational study in the internal medicine hospitalization unit over a year. Descriptive analysis of variables: demographic (age, sex); functional capacity and social assessment. The data obtained from the Gacela Care software application. Results: 1285 admissions were made, with an average age of 78 years. A sample of 915 patients ≥75 years old was obtained, with a mean age of 85.9 ± 5.4 years (75-101), mode 89 and median 86 years. 43.5% are ≥85 years. 53.11% women and 46.88% men. Average hospital stay 7.4 ± 5.2 days (0-66). Dependency assessment: 38.57% with total dependence (62.32% women); 9.61% severe dependence (54.54% women); 15.19% moderate dependence (54.67% women); 26.22% mild dependence (47.08% women); 10.38% independent (30.56% women). Social situation: 28.80% without risk (64.63% women); 60.30% good social situation (47.37% women); 6.2% average social situation (56.60% women); and 4.68% severe social deterioration (52.5% women) Conclusions: The profile of the patients studied approximates that of “geriatric patient”. The highest percentage presents a level of total dependence, causing greater demand for care and resources. There are few patients with severe social impairment. There are a greater number of total dependent patients without institutionalizing. Therefore, the burden of care for these patients is carried out by family members from home, justifying the importance of the assessment of caregivers and evaluation of resources related to family overload and primary caregiver.Introducción: El aumento de la población de personas mayores, añadido al aumento de pluripatología y polifarmacia, hace cada vez más frecuente su ingreso en los hospitales. Objetivos: Establecer el perfil del paciente geriátrico mayor de 75 años, con pluripatología y atendido en la Unidad de Medicina Interna del Hospital Virgen de la Concha. Analizar los resultados de la valoración funcional a través de la escala Barthel. Identificar la situación social a través de la escala Gijón. Métodos: Estudio observacional retrospectivo en la unidad de hospitalización de medicina interna a lo largo de un año. Análisis descriptivo de variables: demográficas (edad, sexo); capacidad funcional y la valoración social. Los datos obtenidos del aplicativo informático Gacela Care. Resultados: Se realizaron 1285 ingresos, con una media de edad de 78 años. Se obtuvo una muestra de 915 pacientes ≥75años, con una media de edad de 85,9±5,4años (75-101), moda 89 y mediana 86 años. El 43,5% son ≥85años. 53,11% mujeres y 46,88% hombres. Estancia media de hospitalización 7,4±5,2días (0-66). Valoración de dependencia: 38,57% con dependencia total (62,32% mujeres);9,61% dependencia grave (54,54% mujeres); 15,19% dependencia moderada (54,67% mujeres); 26,22% dependencia leve (47,08% mujeres); 10,38% independientes (30,56% mujeres). Situación social: 28,80%sin riesgo (64,63%mujeres); 60,30%situación social buena (47,37%mujeres); 6,2% situación social media (56,60%mujeres); y el 4,68% deterioro social severo (52,5% mujeres) Conclusiones: El perfil de los pacientes estudiados se aproxima al de “paciente geriátrico”. El mayor porcentaje presenta un nivel de dependencia total, provocando mayor demanda de cuidados y de recursos. Existen pocos pacientes con deterioro social severo. Hay un mayor número de pacientes  dependientes totales sin institucionalizar. Por lo que la carga de cuidados de estos pacientes la realizan familiares desde el domicilio, justificando la importancia de la valoración de los cuidadores y evaluación de los recursos referidos a la sobrecarga de familias y cuidador principal

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio