Factores de riesgo en pacientes con diagnóstico de neumonía asociada a la ventilación mecánica en la unidad de cuidados intensivos del Hospital Universidad del Norte en el año 2015-2018

26 en el Hospital Universidad del Norte (HUN). Se realizó un estudio retrospectivo, observacional, analítico de casos y controles, realizado en la Unidad de cuidados intensivos (UCI) del HUN. Se incluyeron pacientes que ingresaron durante el periodo de enero del 2015 hasta octubre del 2018 y que requirieron ventilación mecánica por más de 48 horas. El número total de pacientes fue de 96, el número de casos fue de 19 pacientes, y de controles fue de 75, con una media de edad de 58,2 años y el sexo masculino fue predominante (62,10%), la causa predominante de ingreso a UCI fueron post quirúrgicos, la comorbilidad hipertensión arterial represento un 55,79%, siendo la más predominante. Puntaje apache > 18 no tuvo asociación estadísticamente significativa al igual que las demás variables del estudio.PregradoMedic

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