Serological evolution in women with positive antiphospholipid antibodies

Objectives To explore the clinical and serological course of fertile women with positive antiphospholipid (aPL), and the factors and therapeutic implications associated with aPL negativization. Methods Retrospective study including 105 women with a positive aPL serology between 1995 and 2013 attending the obstetric autoimmune pathology clinic of a tertiary facility. Patients were classified into the following 3 groups: patients with primary antiphospholipid syndrome (pAPS, 49), patients with a positive serology for aPL, not meeting clinical criteria (42), and patients with systemic lupus erythematosus and a positive aPL serology (14). They were also classified according to the serological aPL evolution: persistently negative aPL, transiently positive serology, and persistently positive serology according to established criteria. Results After a mean follow-up of 114.4 ± 37.2 months, 59% of patients had persistently negative antibodies, while 25.7% of patients presented persistently positive aPL serology. Multivariate analysis confirmed that smoking (OR = 4; 95% CI: 1.45?11.08; p = 0.008) was an independent risk factor for positive persistence. Persistent positivity as well as a higher antibody load was associated with higher risk for further pregnancy morbidity. In 29 patients, with persistently negative serology who were asymptomatic, treatment with low-dose aspirin was discontinued. No clinical events related to APS were reported after treatment withdrawal, during the 40.95 months of follow-up. Conclusions A significant proportion of fertile women with aPL antibodies became negative during follow-up. Tobacco use and the number of positive antibodies are associated with persistently positive serology. Patients with persistently positive aPL serology suffer more obstetric complications. Treatment withdrawal might be safe in selected patients

Healthcare workers hospitalized due to COVID-19 have no higher risk of death than general population. Data from the Spanish SEMI-COVID-19 Registry

Aim To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW). Methods Observational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. Results As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age, male sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.211, 95%CI 0.067-0.667, p = 0.008). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). Conclusions Hospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality

Evolution of serology in women with positive antiphospholipid antibodies

En el presente trabajo se estudió de forma retrospectiva una cohorte de 90 mujeres con positividad confirmada de anticuerpos antifosfolípido (aPL), de acuerdo con los criterios diagnósticos de síndrome antifosfolípido (SAF). Las pacientes fueron clasificadas en 3 grupos: SAF primario (n=40), aPL positivos sin cumplir el criterio clínico de SAF (n=38) y lupus eritematoso sistémico (LES) con aPL positivos (n=12). Después de 119,4±33,0 meses de seguimiento, un 60,0% de las pacientes mostró negativización persistente de los aPL, mientras que en el 24,4% permanecieron persistentemente positivos, de acuerdo con unos criterios preestablecidos. En el análisis multivariante, el tabaquismo demostró ser un factor de riesgo independiente para la persistencia de positividad de los aPL (RR de 3,90, IC 95% 1,42 a 10,70; p=0,008). La persistencia de los aPL durante el seguimiento se asoció con una mayor frecuencia eventos obstétricos durante el seguimiento (p=0,031). El tratamiento resultó eficaz para prevenir eventos incluidos en los criterios de SAF, aunque la frecuencia de complicaciones obstétricas tardías fue mayor. En 5 pacientes que permanecieron asintomáticas y con aPL persistentemente negativos durante un tiempo prolongado se suspendió el tratamiento antiagregante, sin observarse posteriormente eventos clínicos relacionados con el SAF.ABSTRACT: In the current paper a cohort of 90 women with confirmed positivity of antiphospholipid antibodies (aPL), according to diagnostic criteria for antiphospholipid syndrome (APS), was retrospectively studied. Patients were classified into 3 groups: primary APS (n=40), positive aPL without meeting the clinical criteria SAF (n=38) and systemic lupus erythematosus (SLE) with positive aPL (n=12). After 119.4±33.0 months follow-up, 60.0% of the patients showed persistent negativity of aPL, while in 24.4% of them aPL remained persistently positive, according to pre-established criteria. Multivariate analysis proved smoking as an independent risk factor for persistent aPL positivity (RR 3.90, 95% CI 1.42 to 10.70; p=0.008). Persistence of aPL was associated with a greater likelihood of developing obstetric events during follow-up (p=0.031). Treatment proved efficacy in preventing events included amongst APS criteria, although the frequency of obstetric complications increased. In 5 patients with persistently negative aPL who remained asymptomatic for a long time antiplatelet therapy was discontinued and no clinical events related to the SAF were subsequently observed.Grado en Medicin