Estudio nutricional de los pacientes ingresados por insuficiencia cardiaca aguda mediante ODIMET: serie caso-control

En este estudio se pretende, mediante el uso de la herramienta informática ODIMET, realizar un estudio comparativo caso-control del estado nutricional de los pacientes ingresados por insuficiencia cardiaca (IC), y valorar la utilidad que presenta en la práctica clínica diaria. Estudio realizado en el Servicio de Medicina Interna del Hospital Clínico Universitario Lozano Blesa, en Zaragoza. Como resultados se demostraron que existen diferencia significativas, con desnutrición, en los pacientes ingresados por IC en nuestra unidad, respecto a los controles pareados por edad y sexo. Los pacientes con IC aguda presentan una deficiencia no solo en la ingesta calórica sino en lo referente a hidratos de carbono, aminoácidos esenciales, vitaminas del grupo B y C e ingesta proteica respecto a los sujetos control. Este estudio se ha realizado mediante una nueva herramienta sencilla, sin coste, no invasiva, rápida y reproducible, ODIMET, que nos proporcional información clave en lo referente al estado nutricional de los pacientes con insuficiencia cardiaca, con las implicaciones que esto tiene en cuanto al tratamiento, evolución y pronóstico de estos pacientes

Patrones de uso y adecuación de las indicaciones de los ARNI e iSGLT2 en la insuficiencia cardiaca

La insuficiencia cardiaca (IC) es una enfermedad cuya prevalencia va en aumento. Los tratamientos incorporados recientemente a las guías clínicas, como son los fármacos Inhibidores de la Neprilisina y de los Receptores de Angiotensina (ARNIs) y los inhibidores de cotransportador Sodio-Glucosa-2 (iSGLT2), suponen un cambio en el paradigma de tratamiento y pronóstico de esta entidad, especialmente en determinados subgrupos de pacientes.Dada su reciente introducción, no es infrecuente encontrar en las consultas de IC enfermos potencialmente tratables y que, por la razón que sea, no reciben estos fármacos. Así, este estudio pretende analizar la adecuación terapéutica de las últimas guías de insuficiencia cardiaca en pacientes ambulatorios controlados en una consulta monográfica de IC.<br /

Elevated urinary Kidney Injury Molecule 1 (KIM-1) at discharge strongly predicts early mortality following an episode of acute decompensated heart failure

Introduction: Hospitalization for Acute Decompensation of Heart Failure (ADHF) is a frequent event associated with long-term adverse effects. Prognosis is even worse if Acute Kidney Injury (AKI) occurs during hospitalization. Objectives: To determine whether kidney damage biomarkers NGAL, KIM-1 and IL-18 might predict AKI and have prognostic value of in ADHF. Patients and methods: Serum NGAL on admission and urine NGAL, KIM-1 and IL-18 on discharge were determined in 187 ADHF patients enrolled in a prospective, observational, unblinded study. AKI was diagnosed using the KDIGO criteria. Patients were followed-up for 12 months to record all-cause mortality. Results: 22% patients died during follow-up, with 52.5% dying within 4 months after discharge. Serum NGAL (P <0.001), urine NGAL (P = 0.047), and urinary KIM-1 (P = 0.014) levels were significantly higher in deceased patients at discharge. After adjustment for eGFR, only urinary KIM-1 independently predicted mortality at month 4 (HR 3.166, 95%CI 1.203-8.334, P = 0.020) and month 12 (HR 1.969, 95%CI 1.123-3.454, P = 0.018) in Cox regression models. In ROC analysis urinary KIM-1 (AUC = 0.830) outperformed other markers of renal function. Kaplan-Meier survival analysis showed KIM-1 predictive value is additive to that of AKI incidence and admission eGFR. Admission serum NGAL was higher in AKI patients (P ≤0.001) with a modest diagnostic performance (AUC = 0.667), below urea (AUC = 0.732), creatinine (AUC = 0.696), or CysC (AUC = 0.676). Conclusions: Discharge urinary KIM-1 was a strong and independent predictor of mortality, particularly during the most vulnerable period shortly after hospitalization. Admission serum NGAL was inferior to conventional renal function parameters in predicting AKI during ADHF

Point-of-care lung ultrasound assessment for risk stratification and therapy guiding in COVID-19 patients. A prospective non-interventional study.

Background Lung ultrasound is feasible for assessing lung injury caused by coronavirus disease 2019 (COVID-19). However, the prognostic meaning and time-line changes of lung injury assessed by lung ultrasound in COVID-19 hospitalised patients are unknown. Methods Prospective cohort study designed to analyse prognostic value of lung ultrasound in COVID-19 patients by using a quantitative scale (lung ultrasound Zaragoza (LUZ)-score) during the first 72 h after admission. The primary end-point was in-hospital death and/or admission to the intensive care unit. Total length of hospital stay, increase of oxygen flow and escalation of medical treatment during the first 72 h were secondary end-points. Results 130 patients were included in the final analysis; mean±sd age was 56.7±13.5 years. Median (interquartile range) time from the beginning of symptoms to admission was 6 (4–9) days. Lung injury assessed by LUZ-score did not differ during the first 72 h (21 (16–26) points at admission versus 20 (16–27) points at 72 h; p=0.183). In univariable logistic regression analysis, estimated arterial oxygen tension/inspiratory oxygen fraction ratio (PAFI) (hazard ratio 0.99, 95% CI 0.98–0.99; p=0.027) and LUZ-score >22 points (5.45, 1.42–20.90; p=0.013) were predictors for the primary end-point. Conclusions LUZ-score is an easy, simple and fast point-of-care ultrasound tool to identify patients with severe lung injury due to COVID-19, upon admission. Baseline score is predictive of severity along the whole period of hospitalisation. The score facilitates early implementation or intensification of treatment for COVID-19 infection. LUZ-score may be combined with clinical variables (as estimated by PAFI) to further refine risk stratification

Chronic Obstructive Pulmonary Disease in Elderly Patients with Acute and Advanced Heart Failure: Palliative Care Needs—Analysis of the EPICTER Study

Introduction: There are studies that evaluate the association between chronic obstructive pulmonary disease (COPD) and heart failure (HF) but there is little evidence regarding the prognosis of this comorbidity in older patients admitted for acute HF. In addition, little attention has been given to the extracardiac and extrapulmonary symptoms presented by patients with HF and COPD in more advanced stages. The aim of this study was to evaluate the prognostic impact of COPD on mortality in elderly patients with acute and advanced HF and the clinical manifestations and management from a palliative point of view. Methods: The EPICTER study (Epidemiological survey of advanced heart failure) is a cross-sectional, multicenter project that consecutively collected patients admitted for HF in 74 Spanish hospitals. Demographic, clinical, treatment, organ-dependent terminal criteria (NYHA III-IV, LVEF <20%, intractable angina, HF despite optimal treatment), and general terminal criteria (estimated survival <6 months, patient/family acceptance of palliative approach, and one of the following: evidence of HF progression, multiple Emergency Room visits or admissions in the last six months, 10% weight loss in the last six months, and functional impairment) were collected. Terminal HF was considered if the patient met at least one organ-dependent criterion and all the general criteria. Both groups (HF with COPD and without COPD) were compared. A Kaplan-Meier survival analysis was performed to evaluate the presence of COPD on the vital prognosis of patients with HF. Results: A total of 3100 patients were included of which 812 had COPD. In the COPD group, dyspnea and anxiety were more frequently observed (86.2% vs. 75.3%, p = 0.001 and 35.4% vs. 31.2%, p = 0.043, respectively). In patients with a history of COPD, presentation of HF was in the form of acute pulmonary edema (21% vs. 14.4% in patients without COPD, p = 0.0001). Patients with COPD more frequently suffered from advanced HF (28.9% vs. 19.4%; p < 0.001). Consultation with the hospital palliative care service during admission was more frequent when patients with HF presented with associated COPD (94% vs. 6.8%; p = 0.036). In-hospital and six-month follow-up mortality was 36.5% in patients with COPD vs. 30.7% in patients without COPD, p = 0.005. The mean number of hospital admissions during follow-up was higher in patients with HF and COPD than in those with isolated HF (0.63 +/- 0.98 vs. 0.51 +/- 0.84; p < 0.002). Survival analysis showed that patients with a history of COPD had fewer survival days during follow-up than those without COPD (log Rank chi-squared 4.895 and p = 0.027). Conclusions: patients with HF and COPD had more severe symptoms (dyspnea and anxiety) and also a worse prognosis than patients without COPD. However, the prognosis of patients admitted to our setting is poor and many patients with HF and COPD may not receive the assessment and palliative care support they need. Palliative care is necessary in chronic non-oncologic diseases, especially in multipathologic and symptom-intensive patients. This is a clinical care aspect to be improved and evaluated in future research studies

Gender-Based Differences by Age Range in Patients Hospitalized with COVID-19: A Spanish Observational Cohort Study

There is some evidence that male gender could have a negative impact on the prognosis and severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The aim of the present study was to compare the characteristics of coronavirus disease 2019 (COVID-19) between hospitalized men and women with confirmed SARS-CoV-2 infection. This multicenter, retrospective, observational study is based on the SEMI-COVID-19 Registry. We analyzed the differences between men and women for a wide variety of demographic, clinical, and treatment variables, and the sex distribution of the reported COVID-19 deaths, as well as intensive care unit (ICU) admission by age subgroups. This work analyzed 12,063 patients (56.8% men). The women in our study were older than the men, on average (67.9 vs. 65.7 years; p < 001). Bilateral condensation was more frequent among men than women (31.8% vs. 29.9%; p = 0.007). The men needed non-invasive and invasive mechanical ventilation more frequently (5.6% vs. 3.6%, p < 0.001, and 7.9% vs. 4.8%, p < 0.001, respectively). The most prevalent complication was acute respiratory distress syndrome, with severe cases in 19.9% of men (p < 0.001). In men, intensive care unit admission was more frequent (10% vs. 6.1%; p < 0.001) and the mortality rate was higher (23.1% vs. 18.9%; p < 0.001). Regarding mortality, the differences by gender were statistically significant in the age groups from 55 years to 89 years of age. A multivariate analysis showed that female sex was significantly and independently associated with a lower risk of mortality in our study. Male sex appears to be related to worse progress in COVID-19 patients and is an independent prognostic factor for mortality. In order to fully understand its prognostic impact, other factors associated with sex must be considered

Ethnicity and Clinical Outcomes in Patients Hospitalized for COVID-19 in Spain: Results from the Multicenter SEMI-COVID-19 Registry

Background: This work aims to analyze clinical outcomes according to ethnic groups in patients hospitalized for COVID-19 in Spain. (2) Methods: This nationwide, retrospective, multicenter, observational study analyzed hospitalized patients with confirmed COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry) from 1 March 2020 to 31 December 2021. Clinical outcomes were assessed according to ethnicity (Latin Americans, Sub-Saharan Africans, Asians, North Africans, Europeans). The outcomes were in-hospital mortality (IHM), intensive care unit (ICU) admission, and the use of invasive mechanical ventilation (IMV). Associations between ethnic groups and clinical outcomes adjusted for patient characteristics and baseline Charlson Comorbidity Index values and wave were evaluated using logistic regression. (3) Results: Of 23,953 patients (median age 69.5 years, 42.9% women), 7.0% were Latin American, 1.2% were North African, 0.5% were Asian, 0.5% were Sub-Saharan African, and 89.7% were European. Ethnic minority patients were significantly younger than European patients (median (IQR) age 49.1 (40.5-58.9) to 57.1 (44.1-67.1) vs. 71.5 (59.5-81.4) years, p < 0.001). The unadjusted IHM was higher in European (21.6%) versus North African (11.4%), Asian (10.9%), Latin American (7.1%), and Sub-Saharan African (3.2%) patients. After further adjustment, the IHM was lower in Sub-Saharan African (OR 0.28 (0.10-0.79), p = 0.017) versus European patients, while ICU admission rates were higher in Latin American and North African versus European patients (OR (95%CI) 1.37 (1.17-1.60), p < 0.001) and (OR (95%CI) 1.74 (1.26-2.41), p < 0.001). Moreover, Latin American patients were 39% more likely than European patients to use IMV (OR (95%CI) 1.43 (1.21-1.71), p < 0.001). (4) Conclusion: The adjusted IHM was similar in all groups except for Sub-Saharan Africans, who had lower IHM. Latin American patients were admitted to the ICU and required IMV more often

Comorbidities in heart failure with mid-range ejection fraction

Dear Sir, The recent Guidelines of heart failure (HF) of the European Society of Cardiology (ESC) propose an emerging classification of HF according to left ventricular ejection fraction (LVEF). Namely, patients with LVEF between 40 and 50% are classified in an intermediate group termed HF with mid-range ejection fraction (HFmrEF). Although the authors acknowledge that this subtle distinction may account for important differences in underlying aetiologies, demographics, co-morbidities and response to therapies, the group, as a whole, is suggested as a mild systolic dysfunction with features of diastolic dysfunction (sic)..