3 research outputs found
Comparación de distintas estrategias para la predicción de muerte a corto plazo en el paciente anciano infectado
Objective. The aim of this study was to determine the utility of a post hoc lactate added to SIRS and qSOFA score to predict 30-day mortality in older non-severely dependent patients attended for infection in the Emergency Department (ED).
Methods. We performed an analytical, observational, prospective cohort study including patients of 75 years of age or older, without severe functional dependence, attended for an infectious disease in 69 Spanish ED for 2-day three seasonal periods. Demographic, clinical and analytical data were collected. The primary outcome was 30-day mortality after the index event.
Results. We included 739 patients with a mean age of 84.9 (SD 6.0) years; 375 (50.7%) were women. Ninety-one (12.3%) died within 30 days. The AUC was 0.637 (IC 95% 0.587-0.688; p= 2 and 0.698 (IC 95% 0.635- 0.761; p= 2. Comparing receiver operating characteristic (ROC) there was a better accuracy of qSOFA vs SIRS (p=0.041). Both scales improve the prognosis accuracy with lactate inclusion. The AUC was 0.705 (IC95% 0.652-0.758; p<0.001) for SIRS plus lactate and 0.755 (IC95% 0.696-0.814; p<0.001) for qSOFA plus lactate, showing a trend to statistical significance for the second strategy (p=0.0727). Charlson index not added prognosis accuracy to SIRS (p=0.2269) or qSOFA (p=0.2573).
Conclusions. Lactate added to SIRS and qSOFA score improve the accuracy of SIRS and qSOFA to predict short-term mortality in older non-severely dependent patients attended for infection. There is not effect in adding Charlson index
Cardiometabolic characterization in metabolic dysfunction-associated fatty liver disease
BackgroundTo better understand the patient's heterogeneity in fatty liver disease (FLD), metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed by international experts as a new nomenclature for nonalcoholic fatty liver disease (NAFLD). We aimed to evaluate the cardiovascular risk, assessed through coronary artery calcium (CAC) and epicardial adipose tissue (EAT), of patients without FLD and patients with FLD and its different subtypes. MethodsCross sectional study of 370 patients. Patients with FLD were divided into 4 groups: FLD without metabolic dysfunction (non-MD FLD), MAFLD and the presence of overweight/obesity (MAFLD-OW), MAFLD and the presence of two metabolic abnormalities (MAFLD-MD) and MAFLD and the presence of T2D (MAFLD-T2D). MAFLD-OW included two subgroups: metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO). The patients without FLD were divided into 2 groups: patients without FLD and without MD (non-FLD nor MD; reference group) and patients without FLD but with MD (non-FLD with MD). EAT and CAC (measured through the Agatston Score) were determined by computed tomography. ResultsCompared with the reference group (non-FLD nor MD), regarding EAT, patients with MAFLD-T2D and MAFLD-MUHO had the highest risk for CVD (OR 15.87, 95% CI 4.26-59.12 and OR 17.60, 95% CI 6.71-46.20, respectively), patients with MAFLD-MHO were also at risk for CVD (OR 3.62, 95% CI 1.83-7.16), and patients with non-MD FLD did not have a significantly increased risk (OR 1.77; 95% CI 0.67-4.73). Regarding CAC, patients with MAFLD-T2D had an increased risk for CVD (OR 6.56, 95% CI 2.18-19.76). Patients with MAFLD-MUHO, MAFLD-MHO and non-MD FLD did not have a significantly increased risk compared with the reference group (OR 2.54, 95% CI 0.90-7.13; OR 1.84, 95% CI 0.67-5.00 and OR 2.11, 95% CI 0.46-9.74, respectively). ConclusionMAFLD-T2D and MAFLD-OW phenotypes had a significant risk for CVD. MAFLD new criteria reinforced the importance of identifying metabolic phenotypes in populations as it may help to identify patients with higher CVD risk and offer a personalized therapeutic management in a primary prevention setting
Incidencia y mortalidad por cáncer en Navarra, 1998-2002. Evolución en los últimos 30 años
Entre 1998-2002 se registraron 16.952 nuevos casos de cáncer en Navarra. En los hombres, los cánceres más frecuentemente diagnosticados fueron, por este orden próstata, pulmón,
colon y recto, vejiga y estómago, que sumaron el 63,2% de todos
los casos de cáncer. En mujeres las localizaciones de mama,
colon y recto, cuerpo de útero, estómago y ovario sumaron el
57,6 % del total de los casos.
En el mismo periodo, 1998-2002, fallecieron por cáncer
4.127 hombres y 2.470 mujeres. El 60 % de todas las muertes
producidas por tumores malignos en hombres se debieron a las
localizaciones de pulmón, próstata, colón y recto, estómago y
vejiga. En las mujeres las localizaciones de colon y recto, mama,
estómago, páncreas y pulmón, sumaron el 49% de las defunciones por cáncer.
En los hombres de Navarra han aumentado las tasas de
incidencia del cáncer de próstata, riñón y linfoma no Hodgkin.
Cánceres evitables, como los relacionados con el hábito de
fumar (pulmón, cavidad oral y faringe o páncreas), continúan en
ascenso, y representan mayor riesgo global de morir por cáncer
en el último periodo estudiado que en las décadas de los años
1970 y 1980. A partir de 1995 y hasta la actualidad, la mortalidad
por cáncer pasó de ocupar el segundo lugar a ser la primera
causa de muerte entre los hombres de Navarra. El riesgo global
de muerte por cáncer en hombres se ha igualado al primer
periodo estudiado 1975-77.
Entre las mujeres el riesgo global de muerte por cáncer
descendió un 25% entre 1975 y 2002, a costa fundamentalmente
del cáncer de mama y de estómago. Los tumores relacionados
con el hábito de fumar muestran incrementos tanto en la mortalidad como en la incidencia y emerge como un problema
importante de salud entre las mujeres de Navarra. Ha aumentado la incidencia de cáncer de mama, en cambio en la mortalidad
se sitúa en cifras inferiores a las del primer periodo 1975-77. El
cáncer invasivo de cérvix se mantiene en tasas muy bajas respecto a muchos países europeos, incluida España.
En ambos sexos han aumentado el cáncer colorrectal y el
melanoma mientras que continúa el descenso de la incidencia y
mortalidad por cáncer de estómago.Between 1998-2002, 16,952 new cases of cancer were
registered in Navarre. In men, the most frequently diagnosed
cancers were in the following order: prostate, lung, colon and
rectum, bladder and stomach, which accounted for 63.2%. In
women, the sites were breast, colon and rectum, corpus uteri,
stomach and ovary, which accounted for 57.6% of the cases.
In the same period, 1998-2002, 4,127 men and 2,470 women
died from cancer. Sixty percent of all deaths due to malign
tumours in men were due to cancer of the lung, prostate, colon
and rectum, stomach and bladder. In women this was due to
cancers of colon and rectum, breast, stomach, pancreas and
lung, which accounted for 49% of the cases.
In men in Navarre there has been an increase in the
incidence rates of cancer of the prostate, kidney and nonHodgkin lymphoma. Avoidable cancers such as those related to
smoking (lung, oral cavity and pharynx or pancreas) continue to
rise, and represent a greater global risk of dying from cancer in
the latest period studied than in the decades of the 1970s and
1980s. From 1995 up to the present, mortality due to cancer has
moved from occupying the second place to become the first
cause of death among men in Navarre. The global risk of death
due to cancer in men is now equal to the first period studied,
1975-1977.
Amongst women the global risk of death due to cancer fell
by 25% between 1975 and 2002, basically at the cost of breast
and stomach cancer. Tumours related to smoking increased
both in mortality and in incidence and appear as a significant
health problem amongst women in Navarre. Breast cancer has
increased in incidence, with lower mortality figures than those
of the first period 1975-1977. Invasive cancer of the cervix
remains at very low rates in comparison with many European
countries, including Spain.
In both sexes colorectal and skin cancer has increased,
while the incidence and mortality of stomach cancer continues
to fall