23 research outputs found
Exploring host genetic polymorphisms involved in SARS-CoV infection autcomes: implications for personalized medicine in COVID-19
Objective. To systematically explore genetic polymorphisms associated with the clinical outcomes in SARS-CoV infection in
humans. Methods. This comprehensive literature search comprised available English papers published in PubMed/Medline and
SCOPUS databases following the PRISMA-P guidelines and PICO/AXIS criteria. Results. Twenty-nine polymorphisms located
in 21 genes were identified as associated with SARS-CoV susceptibility/resistance, disease severity, and clinical outcomes
predominantly in Asian populations. Thus, genes implicated in key pathophysiological processes such as the mechanisms
related to the entry of the virus into the cell and the antiviral immune/inflammatory responses were identified. Conclusions.
Although caution must be taken, the results of this systematic review suggest that multiple genetic polymorphisms are
associated with SARS-CoV infection features by affecting virus pathogenesis and host immune response, which could have
important applications for the study and understanding of genetics in SARS-CoV-2/COVID-19 and for personalized
translational clinical practice depending on the population studied and associated environments
Performance of SAPS II and SAPS 3 in Intermediate Care
Objective: The efficacy and reliability of prognostic scores has been described extensively for intensive care, but
their role for predicting mortality in intermediate care patients is uncertain. To provide more information in this field,
we have analyzed the performance of the Simplified Acute Physiology Score (SAPS) II and SAPS 3 in a single center
intermediate care unit (ImCU).
Materials and Methods: Cohort study with prospectively collected data from all patients admitted to a single center
ImCU in Pamplona, Spain, from April 2006 to April 2012. The SAPS II and SAPS 3 scores with respective predicted
mortality rates were calculated according to standard coefficients. Discrimination was evaluated by calculating the
area under receiver operating characteristic curve (AUROC) and calibration with the Hosmer-Lemeshow goodness of
fit test. Standardized mortality ratios (SMR) with 95% confidence interval (95% CI) were calculated for each model.
Results: The study included 607 patients. The observed in-hospital mortality was 20.1% resulting in a SMR of 0.87
(95% CI 0.73-1.04) for SAPS II and 0.56 (95% CI 0.47-0.67) for SAPS 3. Both scores showed acceptable
discrimination, with an AUROC of 0.76 (95% CI 0.71-0.80) for SAPS II and 0.75 (95% CI 0.71- 0.80) for SAPS 3.
Calibration curves showed similar performance based on Hosmer-Lemeshow goodness of fit C-test: (X2=12.9,
p=0.113) for SAPS II and (X2=4.07, p=0.851) for SAPS 3.
Conclusions: Although both scores overpredicted mortality, SAPS II showed better discrimination for patients
admitted to ImCU in terms of SMR
The urgent need for integrated science to fight COVID-19 pandemic and beyond
The COVID-19 pandemic has become the leading societal concern. The pandemic has shown that the public health
concern is not only a medical problem, but also afects society as a whole; so, it has also become the leading scientifc
concern. We discuss in this treatise the importance of bringing the worldâs scientists together to fnd efective soluâ
tions for controlling the pandemic. By applying novel research frameworks, interdisciplinary collaboration promises to
manage the pandemicâs consequences and prevent recurrences of similar pandemics
Exploring host genetic polymorphisms involved in SARS-CoV infection autcomes: implications for personalized medicine in COVID-19
Objective. To systematically explore genetic polymorphisms associated with the clinical outcomes in SARS-CoV infection in
humans. Methods. This comprehensive literature search comprised available English papers published in PubMed/Medline and
SCOPUS databases following the PRISMA-P guidelines and PICO/AXIS criteria. Results. Twenty-nine polymorphisms located
in 21 genes were identified as associated with SARS-CoV susceptibility/resistance, disease severity, and clinical outcomes
predominantly in Asian populations. Thus, genes implicated in key pathophysiological processes such as the mechanisms
related to the entry of the virus into the cell and the antiviral immune/inflammatory responses were identified. Conclusions.
Although caution must be taken, the results of this systematic review suggest that multiple genetic polymorphisms are
associated with SARS-CoV infection features by affecting virus pathogenesis and host immune response, which could have
important applications for the study and understanding of genetics in SARS-CoV-2/COVID-19 and for personalized
translational clinical practice depending on the population studied and associated environments
Estimation of fatty liver disease clinical role on glucose metabolic remodelling phenotypes and T2DM onset
Introduction: Metabolic syndrome (MetS), prediabetes (PreDM) and Fatty Liver
Disease (FLD) share pathophysiological pathways concerning type 2 diabetes
mellitus (T2DM) onset. The non-invasive assessment of fatty liver combined with
PreDM and MetS features screening might provide further accuracy in predicting
hyperglycemic status in the clinical setting with the putative description of singu-
lar phenotypes. The objective of the study is to evaluate and describe the links of a
widely available FLD surrogate -the non-invasive serological biomarker Hepatic
Steatosis Index (HSI)- with previously described T2DM risk predictors, such as
preDM and MetS in forecasting T2DM onset.
Patients and methods: A retrospective ancillary cohort study was performed
on 2799 patients recruited in the Vascular-Metabolic CUN cohort. The main out-
come was the incidence of T2DM according to ADA criteria. MetS and PreDM
were defined according to ATP III and ADA criteria, respectively. Hepatic stea-
tosis index (HSI) with standardized thresholds was used to discriminate patients
with FLD, which was referred as estimated FLD (eFLD).
Results: MetS and PreDM were more common in patients with eFLD as com-
pared to those with an HSI < 36 points (35% vs 8% and 34% vs. 18%, respectively).
Interestingly, eFLD showed clinical effect modification with MetS and PreDM
in the prediction of T2DM [eFLD-MetS interaction HR = 4.48 (3.37-5.97) and
eFLD-PreDM interaction HR = 6.34 (4.67-8.62)]. These findings supported thedescription of 5 different liver status-linked phenotypes with increasing risk of
T2DM: Control group (1,5% of T2DM incidence), eFLD patients (4,4% of T2DM
incidence), eFLD and MetS patients (10,6% of T2DM incidence), PreDM patients
(11,1% of T2DM incidence) and eFLD and PreDM patients (28,2% of T2DM inci-
dence). These phenotypes provided independent capacity of prediction of T2DM
incidence after adjustment for age, sex, tobacco and alcohol consumption, obesity
and number of SMet features with a c-Harrell=0.84.
Conclusion: Estimated Fatty Liver Disease using HSI criteria (eFLD) interplay
with MetS features and PreDM might help to discriminate patient risk of T2DM
in the clinical setting through the description of independent metabolic risk
phenotypes.
[Correction added on 15 June 2023, after first online publication: The abstract
section was updated in this current version.
Antioxidant lifestyle, co-morbidities and quality of life empowerment concerning liver fibrosis
The assessment of liver fibrosis has gained importance since the progression of non-alcoholic fatty liver disease (NAFLD). Indeed, the description of the association between undetected liver fibrosis and lifestyle in terms of antioxidant habits, comorbidity and quality of life (QoL) domains may help in the characterization of subjects with NAFLD. A cross-sectional evaluation of (n = 116) consecutive patients from an Internal Medicine ambulatory evaluation was performed. Demographic data, lifestyle, co-morbidity, QoL (according to the SF-36 index) and analytical values to calculate the oxidative related Fibrosis-4 (FIB-4) index were recorded. The association between FIB-4 and co-morbidity, antioxidant habits in QoL was assessed in univariate analysis (p < 0.05) and confirmed in multivariable analysis for 4 of the 8 SF-36 categories: Physical QoL, Physical role, Social QoL and General QoL, as well as in the Physical summary of SF-36 (p < 0.05). Finally, interactions were assessed between co-morbidity, FIB-4 and antioxidant habits showed in the prediction of mean SF-36 (p < 0.01). Liver fibrosis assessed by the oxidative surrogate index FIB-4 is associated with the interaction between antioxidant lifestyle, co-morbidity and physical, social and general aspects of QoL in apparent liver disease-free individuals, generating a proof of concept for health empowerment and personalized medicine
Antioxidant lifestyle, co-morbidities and quality of life empowerment concerning liver fibrosis
The assessment of liver fibrosis has gained importance since the progression of non-alcoholic fatty liver disease (NAFLD). Indeed, the description of the association between undetected liver fibrosis and lifestyle in terms of antioxidant habits, comorbidity and quality of life (QoL) domains may help in the characterization of subjects with NAFLD. A cross-sectional evaluation of (n = 116) consecutive patients from an Internal Medicine ambulatory evaluation was performed. Demographic data, lifestyle, co-morbidity, QoL (according to the SF-36 index) and analytical values to calculate the oxidative related Fibrosis-4 (FIB-4) index were recorded. The association between FIB-4 and co-morbidity, antioxidant habits in QoL was assessed in univariate analysis (p < 0.05) and confirmed in multivariable analysis for 4 of the 8 SF-36 categories: Physical QoL, Physical role, Social QoL and General QoL, as well as in the Physical summary of SF-36 (p < 0.05). Finally, interactions were assessed between co-morbidity, FIB-4 and antioxidant habits showed in the prediction of mean SF-36 (p < 0.01). Liver fibrosis assessed by the oxidative surrogate index FIB-4 is associated with the interaction between antioxidant lifestyle, co-morbidity and physical, social and general aspects of QoL in apparent liver disease-free individuals, generating a proof of concept for health empowerment and personalized medicine
Performance of SAPS II and SAPS 3 in Intermediate Care
Objective: The efficacy and reliability of prognostic scores has been described extensively for intensive care, but
their role for predicting mortality in intermediate care patients is uncertain. To provide more information in this field,
we have analyzed the performance of the Simplified Acute Physiology Score (SAPS) II and SAPS 3 in a single center
intermediate care unit (ImCU).
Materials and Methods: Cohort study with prospectively collected data from all patients admitted to a single center
ImCU in Pamplona, Spain, from April 2006 to April 2012. The SAPS II and SAPS 3 scores with respective predicted
mortality rates were calculated according to standard coefficients. Discrimination was evaluated by calculating the
area under receiver operating characteristic curve (AUROC) and calibration with the Hosmer-Lemeshow goodness of
fit test. Standardized mortality ratios (SMR) with 95% confidence interval (95% CI) were calculated for each model.
Results: The study included 607 patients. The observed in-hospital mortality was 20.1% resulting in a SMR of 0.87
(95% CI 0.73-1.04) for SAPS II and 0.56 (95% CI 0.47-0.67) for SAPS 3. Both scores showed acceptable
discrimination, with an AUROC of 0.76 (95% CI 0.71-0.80) for SAPS II and 0.75 (95% CI 0.71- 0.80) for SAPS 3.
Calibration curves showed similar performance based on Hosmer-Lemeshow goodness of fit C-test: (X2=12.9,
p=0.113) for SAPS II and (X2=4.07, p=0.851) for SAPS 3.
Conclusions: Although both scores overpredicted mortality, SAPS II showed better discrimination for patients
admitted to ImCU in terms of SMR
Mortality Prediction in Patients Undergoing Non-Invasive Ventilation in Intermediate Care
Background
Intermediate Care Units (ImCU) have become an alternative scenario to perform Non-Inva-
sive Ventilation (NIV). The limited number of prognostic studies in this population support
the need of mortality prediction evaluation in this context.
Objective
The objective of this study is to analyze the performance of Simplified Acute Physiology
Score (SAPS) II and 3 in patients undergoing NIV in an ImCU. Additionally, we searched for
new variables that could be useful to customize these scores, in order to improve mortality
prediction.
Design
Cohort study with prospectively collected data from all patients admitted to a single center
ImCU who received NIV. The SAPS II and 3 scores with their respective predicted mortality
rates were calculated. Discrimination and calibration were evaluated by calculating the area
under the receiver operating characteristic curve (AUC) and with the Hosmer-Lemeshow
goodness of fit test for the models, respectively. Binary logistic regression was used to iden-
tify new variables to customize the scores for mortality prediction in this setting.
Patients
The study included 241 patients consecutively admitted to an ImCU staffed by hospitalists
from April 2006 to December 2013. Key Results
The observed in-hospital mortality was 32.4% resulting in a Standardized Mortality Ratio
(SMR) of 1.35 for SAPS II and 0.68 for SAPS 3. Mortality discrimination based on the AUC
was 0.73 for SAPS II and 0.69 for SAPS 3. Customized models including immunosuppres-
sion, chronic obstructive pulmonary disease (COPD), acute pulmonary edema (APE), lactic
acid, pCO2 and haemoglobin levels showed better discrimination than old scores with simi-
lar calibration power.
Conclusions
These results suggest that SAPS II and 3 should be customized with additional patient-risk
factors to improve mortality prediction in patients undergoing NIV in intermediate care