Trasplante hepático con donantes en asistolia incontrolados

[Resumen] Los donantes en asistolia ser una alternativa para incrementar el numero de organos necesarios para trasplante las experiencias previas con donantes en asistolia en trasplante hepatico se han limitado principalmente a donantes controlados en este trabajo se analizan los resultados obtenidos en trasplante hepaticos con donantes en asistolia incontrolados usando tres metodos para preservar los organos del potencial donante tras reanimacion cendropulmonar refructosa. Desde diciembre 1995 a Mayo 2000, se realizaron 22 trasplantes hepaticos con organos procedentes de donantes en asistolia. Se utilizaron 3 metodos para preservar los organos: perfusion in situ (2 pacientes), cendrocompresor y contrapulsacion normal abdominial (6 pacientes), by-pos cardiopulmonar(14 pacientes). La supervivencia del paciente fue de 82% y del reparto del 49%. Los pacientes receptores de un donante en asistolia presentaron mayor incidencia de fallo de reparto (36 %), peor funcion sintetica y mayor daño hepatocelular y una incidencia de complicaciones biliares del 27%). En el grupo de perfusion in situ los dos repartos fracasan. En el grupo de donantes mantenido con cardiocompresor tan solo un infarto pracera (16%). En el grupo de donantes mantenidos combypass injertos fracasaron (36%). Analizando factores relacionados con el proceso del injerto en el grupo de bypass se encuentra que el tiempo de mantenimiento del donante y el tiempo de bypass fueron significativamente mas prolongados en el grupo de injertos no funcionantes

Concordance among methods of nutritional assessment in patients included on the waiting list for liver transplantation

[Abstract] Background: The aim of the present study was to determine the extent of malnutrition in patients waiting for a liver transplant. The agreement among the methods of nutritional assessment and their diagnostic validity were evaluated. Methods: Patients on the waiting list for liver transplantation (n = 110) were studied. The variables were: body mass index, analytical parameters, liver disease etiology, and complications. Liver dysfunction was evaluated using the Child-Pugh Scale. Nutritional state was studied using the Controlling Nutritional Status (CONUT), the Spanish Society of Parenteral and Enteral Nutrition (SENPE) criteria, the Nutritional Risk Index (NRI), the Prognostic Nutritional Index (PNI-O), and the Subjective Global Assessment (SGA). Agreement was determined using the Kappa index. Area under receiver operator characteristic curves (AUCs), the Youden index (J), and likelihood ratios were computed. Results: Malnutrition varied depending on the method of evaluation. The highest value was detected using the CONUT (90.9%) and the lowest using the SGA (50.9%). The pairwise agreement among the methods ranged from K = 0.041 to K = 0.826, with an overall agreement of each criteria with the remaining methods between K = 0.093 and K = 0.364. PNI-O was the method with the highest overall agreement. Taking this level of agreement into account, we chose the PNI-O as a benchmark method of comparison. The highest positive likelihood ratio for the diagnosis of malnutrition was obtained from the Nutritional Risk Index (13.56). Conclusions: Malnutrition prevalence is high and prevalence estimates vary according the method used, with low concordance among methods. PNI-O and NRI are the most consistent methods to identify malnutrition in these patients.Instituto de Salud Carlos III; PI11/012

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