Estenosi aòrtica quirúrgica: factors de risc i qualitat de vida

Objectius: Estudiar l’associació de factors de risc d’estenosi aòrtica (EA) greu i estimar l’impacte d’aquesta patologia en la qualitat de vida en pacients ≥65 anys de les comarques de Lleida en el període 11/02/2014 a 14/04/2018. Mètodes: Es va realitzar un estudi epidemiològic de casos i controls aparellat. Per cada cas incident d’EA greu es van seleccionar controls aparellats per edat, gènere i àmbit d’Atenció Primària. Es va realitzar una anàlisi descriptiva de la sèrie de casos i una anàlisi bivariada i multivariada de l’estudi de casos i controls. L’associació dels diferents factors es va estudiar amb l’odds ratio ajustada (ORa) i els seus intervals de confiança (IC) del 95% mitjançant models de regressió logística. Resultats: La supervivència acumulada dels pacients amb EA greu del grup de Tractament Mèdic estava significativament disminuïda. En l’anàlisi multivariant els factors de risc cardiovasculars associats amb l’EA greu van ser: el tabaquisme (ORa=2,60; IC95%:1,48–4,58), la hipertensió arterial (ORa=2,41; IC95%:1,23–4,72), la hipercolesterolèmia (ORa=2,67; IC95%:1,54–4,64) i els nivells baixos de colesterol HDL (ORa=2,20; IC95%:1,25–3,88). Les comorbiditats associades vas ser la insuficiència renal crònica (ORa=3,78; IC95: 1,88–9,21), l’accident vascular cerebral (ORa=4,14; IC95%: 1,20–14,2) i l’estenosi carotídia (ORa=14,5; IC95%: 1,61 – 129). El qüestionari de qualitat de vida EuroQol 5D-5L, va detectar una pitjor valoració de la realització d’activitats quotidianes (ORa=2,10; IC95%:1,50-3,01) i de l’escala analògica visual (EVA >70: ORa=0,40; IC95%:0,17-0,82) en els pacients amb EA greu. De la mateixa manera, el qüestionari de salut SF-12 va revelar una pitjor valoració de les components sumàries física (ORa=0,89; IC95%:0,83-0,92) i mental (ORa=0,80; IC95%:0,74-0,88) i del dolor com a limitant d’activitats (ORa=0.42; IC95%:0,24-0,76) i de les dimensions Funció Física (ORa=0.94; IC95%:0,90-0,98), Rol Físic (ORa=0.89; IC95%:0,79-1,00) i Funció Social (ORa=0.95; IC95%:0,91-0,98) . No es va observar associació amb el polimorfisme rs10455872. Conclusions: Els pacients amb EA greu tractats mèdicament presenten pitjor supervivència. El tabaquisme, la hipertensió arterial, la hipercolesterolèmia i les nivells baixos de colesterol HDL s’associen amb l’EA greu. Les comorbiditats que s’associen són la insuficiència renal crònica, l’accident vascular cerebral i l’estenosi carotídia. Els instruments de qualitat de vida (EuroQol 5D-5L i SF-12) detecten pitjors puntuacions en l’EA greu i poden ser d’utilitat en assistència i recerca clínica. Per a estudiar la implicació del polimorfisme genètic rs10455872 del gen de la lipoproteïna A en l’EA greu s’han de fer estudis amb suficient potència estadística.Objetivos: Estudiar la asociación de factores de riesgo de estenosis aórtica (EA) grave y estimar el impacto de esta patología en la calidad de vida en pacientes ≥65 años de las comarcas de Lleida en el periodo 11/02/2014 a 14/04/2018. Métodos: Se realizó un estudio epidemiológico de casos y controles apareado. Por cada caso incidente de EA grave fueron seleccionados controles apareados por edad, género y ámbito de Atención Primaria. Se realizó un análisis descriptivo de la serie de casos y un análisis bivariado y multivariado del estudio de casos y controles. La asociación de los diferentes factores fue estudiada con odds ratio ajustada (ORa) y sus intervalos de confianza (IC) del 95% mediante modelos de regresión logística. Resultados: La supervivencia acumulada de los pacientes con EA grave del grupo de Tratamiento Médico estaba significativamente disminuida. En el análisis multivariante los factores de riesgo cardiovasculares asociados a la EA grave fueron: el tabaquismo (ORa=2,60; IC95%:1,48–4,58), la hipertensión arterial (ORa=2,41; IC95%:1,23–4,72), la hipercolesterolemia (ORa=2,67; IC95%:1,54–4,64) y los niveles bajos de colesterol HDL (ORa=2,20; IC95%:1,25–3,88). Las comorbilidades asociadas fueron la insuficiencia renal crónica (ORa=3,78; IC95: 1,88–9,21), el accidente vascular cerebral (ORa=4,14; IC95%: 1,20–14,2) y la estenosis carotídea (ORa=14,5; IC95%: 1,61 – 129). El cuestionario de calidad de vida EuroQol 5D-5L, detectó una peor valoración de la realización de actividades cotidianas (ORa=2,10; IC95%:1,50-3,01) y de la escala analógica visual (EVA >70: ORa=0,40; IC95%:0,17-0,82) en los pacientes con EA grave. El cuestionario de salud SF-12 detectó una peor valoración de las componentes sumarias física (ORa=0,89; IC95%:0,83-0,92) y mental (ORa=0,80; IC95%:0,74-0,88) y del dolor como limitante de actividades (ORa=0.42; IC95%:0,24-0,76) y de las dimensiones Función Física (ORa=0.94; IC95%:0,90-0,98), Rol Físico (ORa=0.89; IC95%:0,79-1,00) y Función Social (ORa=0.95; IC95%:0,91-0,98). No se observó asociación con el polimorfismo rs10455872. Conclusiones: Los pacientes con EA grave tratados médicamente muestran peor supervivencia. El tabaquismo, la hipertensión arterial, la hipercolesterolemia y los niveles bajos de colesterol HDL se asocian con la EA grave. Las comorbilidades que se asocian son la insuficiencia renal crónica, el accidente vascular cerebral y la estenosis carotidea. Los instrumentos de calidad de vida (EuroQol 5D-5L y SF-12) detectan peores puntuaciones en la EA grave y pueden ser de utilidad en la asistencia y la investigación clínicas. Para estudiar la implicación del polimorfismo genético rs10455872 del gen de la lipoproteína A en la EA grave se deben hacer estudios con suficiente potencia estadística.Objectives: To study the association of risk factors with severe aortic stenosis (AS) and to estimate the impact of this pathology on quality of life in patients older than 65 years in the districts of Lleida, Spain from November 2, 2014 to April 14, 2018. Methods: A case-control study was carried out. Each incident case of severe AS was matched with controls in terms of age, gender, and primary care setting. Descriptive analysis of the cases was performed. Bivariate and multivariate analysis of the study of cases and controls was conducted. The association of different factors were investigated by calculating adjusted odds ratios (ORa) and their 95% confidence intervals (CIs) using logistic regression models. Results: Cumulative survival of patients with severe AS was significantly decreased in the medical treatment group. In multivariate analysis, the cardiovascular risk factors associated with severe AS were smoking (ORa = 2.60, 95% CI: 1.48–4.58), arterial hypertension (ORa = 2.41, 95% CI: 1.23–4.72), hypercholesterolemia (ORa = 2.67, 95% CI: 1.54–4.64), and a low high-density lipoprotein cholesterol level (ORa = 2.20, 95% CI: 1.25–3.88). Associated comorbidities were chronic renal failure (ORa = 3.78, 95% CI: 1.88–9.21), stroke (ORa = 4.14, 95% CI: 1.20–14.2), and carotid stenosis (OR = 14.5, 95% CI: 1.61–129). The EuroQol 5D-5L quality of life questionnaire revealed that performance of daily activities (ORa = 2.10, 95% CI: 1.50–3.01) and visual analog scale scores (EVA> 70: ORa = 0.40, 95% CI: 0.17–0.82) were worse in patients with severe AS. Similarly, the SF-12 quality of life questionnaire detected less scores of physical components (ORa = 0.89, 95% CI: 0.83–0.92), mental components (ORa = 0.80, 95% CI: 0.74–0.88), the extent to which pain limited activities (ORa = 0.42, 95% CI: 0.24–0.76), physical function dimensions (ORa = 0.94, 95% CI: 0.90–0.98), physical role (ORa = 0.89, 95% CI: 0.79–1.00), and social function (ORa = 0.95, 95% CI: 0.91–0.98). No association with the genetic polymorphism rs10455872 was found. Conclusions: Survival was worse for medical treated severe AS patients. Smoking, arterial hypertension, hypercholesterolemia, and a low level of high-density lipoprotein cholesterol were associated with severe AS. The comorbidities associated with severe AS were chronic renal failure, stroke, and carotid stenosis. Quality of life questionnaires (EuroQol 5D-5L and SF-12) revealed worse scores in severe AS patients and may be useful in clinical care and research. Studies with greater statistical power are required to study the association between the genetic polymorphism rs10455872, which is present in the lipoprotein A gene, and severe AS

Novel Entropy-Based Metrics for Long-Term Atrial Fibrillation Recurrence Prediction Following Surgical Ablation: Insights from Preoperative Electrocardiographic Analysis

[EN] Atrial fibrillation (AF) is a prevalent cardiac arrhythmia often treated concomitantly with other cardiac interventions through the Cox-Maze procedure. This highly invasive intervention is still linked to a long-term recurrence rate of approximately 35% in permanent AF patients. The aim of this study is to preoperatively predict long-term AF recurrence post-surgery through the analysis of atrial activity (AA) organization from non-invasive electrocardiographic (ECG) recordings. A dataset comprising ECGs from 53 patients with permanent AF who had undergone Cox-Maze concomitant surgery was analyzed. The AA was extracted from the lead V1 of these recordings and then characterized using novel predictors, such as the mean and standard deviation of the relative wavelet energy (RWEm and RWEs) across different scales, and an entropy-based metric that computes the stationary wavelet entropy variability (SWEnV). The individual predictors exhibited limited predictive capabilities to anticipate the outcome of the procedure, with the SWEnV yielding a classification accuracy (Acc) of 68.07%. However, the assessment of the RWEs for the seventh scale (RWEs7), which encompassed frequencies associated with the AA, stood out as the most promising individual predictor, with sensitivity (Se) and specificity (Sp) values of 80.83% and 67.09%, respectively, and an Acc of almost 75%. Diverse multivariate decision tree-based models were constructed for prediction, giving priority to simplicity in the interpretation of the forecasting methodology. In fact, the combination of the SWEnV and RWEs7 consistently outperformed the individual predictors and excelled in predicting post-surgery outcomes one year after the Cox-Maze procedure, with Se, Sp, and Acc values of approximately 80%, thus surpassing the results of previous studies based on anatomical predictors associated with atrial function or clinical data. These findings emphasize the crucial role of preoperative patient-specific ECG signal analysis in tailoring post-surgical care, enhancing clinical decision making, and improving long-term clinical outcomes.This research has received financial support from public grants PID2021-123804OB-I00, PID2021- 00X128525-IV0, and TED2021-130935B-I00 of the Spanish Government, 10.13039/501100011033, in conjunction with the European Regional Development Fund (EU), SBPLY/21/180501/000186, from Junta de Comunidades de Castilla-La Mancha, and AICO/2021/286 from Generalitat Valenciana. Pilar Escribano holds the 2020-PREDUCLM-15540 scholarship co-financed by the European Social Fund (ESF) operating program 2014 2020 of Castilla-La Mancha.Escribano, P.; Ródenas, J.; García, M.; Hornero, F.; Gracia-Baena, JM.; Alcaraz, R.; Rieta, JJ. (2024). Novel Entropy-Based Metrics for Long-Term Atrial Fibrillation Recurrence Prediction Following Surgical Ablation: Insights from Preoperative Electrocardiographic Analysis. Entropy. 26(1). https://doi.org/10.3390/e2601002826

Impact of severe aortic stenosis on quality of life

Stenosis; Quality of life; QuestionnairesEstenosis; Calidad de vida; CuestionariosEstenosi; Qualitat de vida; QüestionarisIntroduction Among individuals ≥ 65 years old, aortic stenosis is highly prevalent and the number of cases is expected to increase in the coming decades, due to the increased life expectancy. Nevertheless, the actual aortic stenosis burden is not well known in population settings and the impact of aortic stenosis on quality of life has not been studied. The aim of this study was to evaluate aortic stenosis impact on health-related quality of life in patients > 65 years old. Methods An epidemiological case-control study was carried out to compare quality of life in patients ≥65 years old with severe symptomatic aortic stenosis. Demographical and clinical information was prospectively obtained and quality of life information was collected with the Short Form Health Survey_v2 (SF-12) questionnaire. The association between quality of life and aortic stenosis was determined using multiple logistic regression models. Results Patients with severe aortic stenosis self-perceived worse quality of life on all dimensions and summary components of the SF-12 questionnaire. In the final multiple logistic regression model a significant inverse association was observed between the dimensions ‘physical role’ and ‘social role’ (p = 0.002 and p = 0.005) and an association close to significance with ‘physical role’ (p = 0.052) of the SF-12 questionnaire. Conclusion The use of quality of life scales allows the assessment of the impact of aortic stenosis on quality of life and may improve the therapeutic approach to severe aortic stenosis, providing evidence for patient‐centered care

Influence of SWEP (Study Pregnant Water Exercise) program in perinatal outcomes: Study protocol

Introducción: el entrenamiento mediante ejercicio físico moderado durante el periodo de gestación aporta beneficios tanto a la mujer embarazada como al feto. Los trabajos de investigación consultados vinculan la actividad física con una reducción del número de cesáreas, de partos instrumentados y con un parto más fisiológico. Previene igualmente la ganancia excesiva de peso de la mujer, disminuye el riesgo de diabetes gestacional y de hipertensión arterial. Objetivo: el objetivo de esta investigación es conocer si un programa de ejercicio físico de carácter moderado con el método Study Water Exercise Pregnant (SWEP), realizado en un medio acuático, contribuye a obtener unos resultados más favorables en la etapa perinatal, tanto para la mujer como para el bebé. Material y métodos: el diseño que se llevará a cabo es un ensayo clínico aleatorizado. La muestra estará constituida por 364 gestantes, obtenida de un universo total de 6.579 partos acontecidos en Granada (España) durante el año 2014. Dicha muestra se ha dividido en dos grupos, uno de intervención y otro de control. La actividad se realizará en las instalaciones deportivas acuáticas de la Facultad de Ciencias del Deporte de la Universidad de Granada, que cuentan con dos vasos adecuados a nuestros objetivos, uno polivalente de 25 metros y otro de enseñanza de 12,5 metros. Resultados: el programa de ejercicios diseñado específicamente para el proyecto denominado SWEP, abarca desde la 20 hasta la 37 semana de gestación (SG) y consta de tres sesiones semanales, con una duración de 60 minutos cada una. Las sesiones incluirán tres fases: fase de calentamiento, fase principal en la que el ejercicio se divide en una parte aeróbica y otra de ejercicios de fuerza y resistencia y una final con estiramientos y relajación. Las variables que se van a estudiar son las siguientes: a) maternas: peso, IMC, tensión arterial, test de O´Sullivan, aparición de depresión postparto, nivel de autopercepción de salud, calidad del sueño y esfuerzo percibido durante la actividad física; b) fetales: peso, test de Apgar, perímetro cefálico y SG (semana de gestación al nacimiento); c) periparto: tiempos de dilatación, expulsivo y alumbramiento, tipo de parto, presencia de episiotomía, tipo de alimentación que recibe el RN y tiempo de lactancia materna exclusiva; y d) descriptivas: edad, profesión, nivel de estudios, tipo de ejercicio físico realizado previamente y FO (fórmula obstétrica). Conclusión: con la actividad física acuática moderada, por parte de la embarazada (método SWEP), se pretenden mejorar las variables arriba indicadas.Introduction: Moderate exercise training during the pregnancy benefits both the pregnant woman and the fetus. The research papers consulted have linked physical activity with the reduction of the number of cesareans, instrumental delivery and with a more physiological delivery. It also prevents excessive weight gain in women and decreases the risk of gestational diabetes and high blood pressure. Aims: The aim of this research is to know if an exercise program of moderate character with Water Study Exercise Pregnant (SWEP) method, performed in an aquatic environment, contributes to have more favorable results in the perinatal period, both for women and baby. Material and methods: The design is a randomized clinical trial. The sample will consist of 364 pregnant women, with a total universe of 6,579 births occurred in Granada (Spain) during 2014. The sample was divided into two groups, intervention group and control group. The activity will be carried out in the water sporting facilities of the Faculty of Sports Science of the University of Granada, which have two pools suitable for our purposes: a 25-meter polyvalent pool and a 12.5-meter pool for training. Results: The exercise program designed specifically for the project called SWEP is performed from 20 to 37 weeks of gestation (SG), and it consists of three weekly sessions, with duration of 60 minutes each. Sessions will include three phases: warm-up phase, the main phase in which the exercise is divided into an aerobic phase and strength training and endurance training phase and a final phase of stretching and relaxation. The variables that will be studied are: a) Maternal: weight, BMI, blood pressure, O’Sullivan test, postpartum depression, level of self-rated health, sleep quality and perceived exertion during physical activity; b) fetal: weight, Apgar scores, head circumference and GA (Gestational age); c) peripartum: time dilation, expulsion and delivery, type of delivery, episiotomy, type of feed received by the RN and time of exclusive breastfeeding; and d) descriptive: age, occupation, education level, type of exercise done before and OF (obstetric formula). Conclusion: With aquatic moderate physical activity during pregnancy (method SWEP), we intended to improve the variables above

Response of the human myocardium to ischemic injury and preconditioning: The role of cardiac and comorbid conditions, medical treatment, and basal redox status

Vàlvula aòrtica; Isquèmia; MiocardiVálvula aórtica; Isquemia; MiocardioAortic valve; Ischemia; MyocardiumBackground The diseased human myocardium is highly susceptible to ischemia/reoxygenation (I/R)-induced injury but its response to protective interventions such as ischemic preconditioning (IPreC) is unclear. Cardiac and other pre-existing clinical conditions as well as previous or ongoing medical treatment may influence the myocardial response to I/R injury and protection. This study investigated the effect of both on myocardial susceptibility to I/R-induced injury and the protective effects of IPreC. Methods and results Atrial myocardium from cardiac surgery patients (n = 300) was assigned to one of three groups: aerobic control, I/R alone, and IPreC. Lactate dehydrogenase leakage, as a marker of cell injury, and cell viability were measured. The basal redox status was determined in samples from 90 patients. The response to I/R varied widely. Myocardium from patients with aortic valve disease was the most susceptible to injury whereas myocardium from dyslipidemia patients was the least susceptible. Tissue from females was better protected than tissue from males. Myocardium from patients with mitral valve disease was the least responsive to IPreC. The basal redox status was altered in the myocardium from patients with mitral and aortic valve disease. Conclusions The response of the myocardium to I/R and IPreC is highly variable and influenced by the underlying cardiac pathology, dyslipidemia, sex, and the basal redox status. These results should be taken into account in the design of future clinical studies on the prevention of I/R injury and protection.This study was supported by the Instituto de Salud Carlos III (FIS) [grant number 12/00119]

Impacto de la COVID-19 en los servicios de cirugía cardiovascular en España: Análisis de los grupos relacionados con el diagnóstico (Estudio SECCE-COVID-19 fase 2)

Introducción y objetivos La pandemia por COVID-19 causada por infección del virus SARS-CoV-2 ha saturado al sistema sanitario español, afectándose la atención de las enfermedades cardiovasculares. Queremos cuantificar el impacto de la pandemia en el número de las intervenciones quirúrgicas cardíacas analizando los grupos relacionados con el diagnóstico (GRD) más prevalentes de nuestra especialidad. Métodos A instancias de la Sociedad Española de Cirugía Cardiovascular y Endovascular, se solicitó a todos los centros nacionales que quisieron participar, los datos de los códigos de GRD números 162 (cirugía sobre válvulas cardíacas con infarto o diagnóstico complejo), 163 (cirugía sobre válvulas cardíacas sin infarto o diagnóstico complejo), 165 (bypass coronario con infarto o diagnóstico complejo), 166 (bypass coronario sin infarto o diagnóstico complejo) y 167 (otros procedimientos cardiotorácicos o vasculares torácicos) entre el 1 de marzo de 2020 y el 30 de septiembre de 2020 (siete meses), y como período control las mismas fechas de 2019. Resultados Se recibieron los datos de 24 hospitales, 22 públicos y dos privados. Existió un descenso global en el número de intervenciones del 30% (rango -19 a -42%, p < 0,001) de 4.648 en 2019 a 3.262 en 2020 (-1.386 de diferencia), siendo +7% para el GRD 162 (p = 0,500), -37% para el 163 (p = 0,001), -9% para el 165 (p = 0,304), -32% para el 166 (p = 0,001), y -16% para el 167 (p = 0,062). Conclusiones Existió un descenso global de cirugías estadísticamente significativo en 2020 del 30% respecto del 2019 entre el 1 de marzo y el 30 de septiembre

Effectiveness of Fosfomycin for the Treatment of Multidrug-Resistant Escherichia coli Bacteremic Urinary Tract Infections

IMPORTANCE The consumption of broad-spectrum drugs has increased as a consequence of the spread of multidrug-resistant (MDR) Escherichia coli. Finding alternatives for these infections is critical, for which some neglected drugs may be an option. OBJECTIVE To determine whether fosfomycin is noninferior to ceftriaxone or meropenem in the targeted treatment of bacteremic urinary tract infections (bUTIs) due to MDR E coli. DESIGN, SETTING, AND PARTICIPANTS This multicenter, randomized, pragmatic, open clinical trial was conducted at 22 Spanish hospitals from June 2014 to December 2018. Eligible participants were adult patients with bacteremic urinary tract infections due to MDR E coli; 161 of 1578 screened patients were randomized and followed up for 60 days. Data were analyzed in May 2021. INTERVENTIONS Patients were randomized 1 to 1 to receive intravenous fosfomycin disodium at 4 g every 6 hours (70 participants) or a comparator (ceftriaxone or meropenem if resistant; 73 participants) with the option to switch to oral fosfomycin trometamol for the fosfomycin group or an active oral drug or pa renteral ertapenem for the comparator group after 4 days. MAIN OUTCOMES AND MEASURES The primary outcome was clinical and microbiological cure (CMC) 5 to 7 days after finalization of treatment; a noninferiority margin of 7% was considered. RESULTS Among 143 patients in the modified intention-to-treat population (median [IQR] age, 72 [62-81] years; 73 [51.0%] women), 48 of 70 patients (68.6%) treated with fosfomycin and 57 of 73 patients (78.1%) treated with comparators reached CMC (risk difference, -9.4 percentage points; 1-sided 95% CI, -21.5 to infinity percentage points; P = .10). While clinical or microbiological failure occurred among 10 patients (14.3%) treated with fosfomycin and 14 patients (19.7%) treated with comparators (risk difference, -5.4 percentage points; 1-sided 95% CI. -infinity to 4.9; percentage points; P = .19), an increased rate of adverse event-related discontinuations occurred with fosfomycin vs comparators (6 discontinuations [8.5%] vs 0 discontinuations; P = .006). In an exploratory analysis among a subset of 38 patients who underwent rectal colonization studies, patients treated with fosfomycin acquired a new ceftriaxone-resistant or meropenem-resistant gram-negative bacteria at a decreased rate compared with patients treated with comparators (0 of 21 patients vs 4 of 17 patients [23.5%]; 1-sided P = .01). CONCLUSIONS AND RELEVANCE This study found that fosfomycin did not demonstrate noninferiority to comparators as targeted treatment of bUTI from MDR E coli; this was due to an increased rate of adverse event-related discontinuations. This finding suggests that fosfomycin may be considered for selected patients with these infections

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

CARB-ES-19 Multicenter Study of Carbapenemase-Producing Klebsiella pneumoniae and Escherichia coli From All Spanish Provinces Reveals Interregional Spread of High-Risk Clones Such as ST307/OXA-48 and ST512/KPC-3

ObjectivesCARB-ES-19 is a comprehensive, multicenter, nationwide study integrating whole-genome sequencing (WGS) in the surveillance of carbapenemase-producing K. pneumoniae (CP-Kpn) and E. coli (CP-Eco) to determine their incidence, geographical distribution, phylogeny, and resistance mechanisms in Spain.MethodsIn total, 71 hospitals, representing all 50 Spanish provinces, collected the first 10 isolates per hospital (February to May 2019); CPE isolates were first identified according to EUCAST (meropenem MIC &gt; 0.12 mg/L with immunochromatography, colorimetric tests, carbapenem inactivation, or carbapenem hydrolysis with MALDI-TOF). Prevalence and incidence were calculated according to population denominators. Antibiotic susceptibility testing was performed using the microdilution method (EUCAST). All 403 isolates collected were sequenced for high-resolution single-nucleotide polymorphism (SNP) typing, core genome multilocus sequence typing (cgMLST), and resistome analysis.ResultsIn total, 377 (93.5%) CP-Kpn and 26 (6.5%) CP-Eco isolates were collected from 62 (87.3%) hospitals in 46 (92%) provinces. CP-Kpn was more prevalent in the blood (5.8%, 50/853) than in the urine (1.4%, 201/14,464). The cumulative incidence for both CP-Kpn and CP-Eco was 0.05 per 100 admitted patients. The main carbapenemase genes identified in CP-Kpn were blaOXA–48 (263/377), blaKPC–3 (62/377), blaVIM–1 (28/377), and blaNDM–1 (12/377). All isolates were susceptible to at least two antibiotics. Interregional dissemination of eight high-risk CP-Kpn clones was detected, mainly ST307/OXA-48 (16.4%), ST11/OXA-48 (16.4%), and ST512-ST258/KPC (13.8%). ST512/KPC and ST15/OXA-48 were the most frequent bacteremia-causative clones. The average number of acquired resistance genes was higher in CP-Kpn (7.9) than in CP-Eco (5.5).ConclusionThis study serves as a first step toward WGS integration in the surveillance of carbapenemase-producing Enterobacterales in Spain. We detected important epidemiological changes, including increased CP-Kpn and CP-Eco prevalence and incidence compared to previous studies, wide interregional dissemination, and increased dissemination of high-risk clones, such as ST307/OXA-48 and ST512/KPC-3

Impact of severe aortic stenosis on quality of life

Introduction Among individuals ≥ 65 years old, aortic stenosis is highly prevalent and the number of cases is expected to increase in the coming decades, due to the increased life expectancy. Nevertheless, the actual aortic stenosis burden is not well known in population settings and the impact of aortic stenosis on quality of life has not been studied. The aim of this study was to evaluate aortic stenosis impact on health-related quality of life in patients > 65 years old. Methods An epidemiological case-control study was carried out to compare quality of life in patients ≥65 years old with severe symptomatic aortic stenosis. Demographical and clinical information was prospectively obtained and quality of life information was collected with the Short Form Health Survey_v2 (SF-12) questionnaire. The association between quality of life and aortic stenosis was determined using multiple logistic regression models. Results Patients with severe aortic stenosis self-perceived worse quality of life on all dimensions and summary components of the SF-12 questionnaire. In the final multiple logistic regression model a significant inverse association was observed between the dimensions ‘physical role’ and ‘social role’ (p = 0.002 and p = 0.005) and an association close to significance with ‘physical role’ (p = 0.052) of the SF-12 questionnaire. Conclusion The use of quality of life scales allows the assessment of the impact of aortic stenosis on quality of life and may improve the therapeutic approach to severe aortic stenosis, providing evidence for patient‐centered care