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

Análisis de la temporada gripal 2017-2018, predominio del linaje Yamagata de la gripe B en los adultos

Introduction: The epidemiological and virological characteristics of the 2017-2018 flu season in its aspects of mortality and age groups are analyzed. Patients and method: Respiratory samples from both the Sentinel Influenza Surveillance Network and patients treated in the emergency room and hospitalized in our center were subjected to the detection of respiratory viruses using a commercial genomic amplification technique, type RT- PCR (Allplex Respiratory Panel, Seegen, North Korea), which identifies 16 different respiratory viruses simultaneously and differentially. Among them influenza viruses A (H1N1) pdm09 and A (H3N2) and influenza virus type B, although no difference between their two lineages. Results: During the flu season, 6,465 respiratory samples were analyzed, of which 3,228 (49.9%) were considered positive (detection of a respiratory virus). Of these, in 1232 a flu virus was detected, representing 19% of all processed samples and 38.2% of all positive samples. Of all the influenza viruses detected, 661 (53.6%) were identified as influenza A and 571 (46.4%) influenza B. The RCVG contributed 127 (10.3%) positive samples, 58 (8.7%) group A and 69 (12%) Influenza B. The rest of the positive samples, 1,105 (89.7%), came from the hospital setting, that is, 603 (91.3%) were influenza A and 502 (88%) were influenza B. Regarding the subtypes of influenza A, They detected 415 (62.7%) cases of the subtype A (H1N1) pdm09, 38 (9.1%) of the RCVG and 377 (90.9%) of the hospital setting. Subtype A (H3N2) detected 246 (37.3%) cases, of which 20 (8.1%) belonged to the RCVG and 226 (91.9%) to the hospital setting. When analyzing the subtypes on the total samples of each provenance, it is verified that of the 58 cases of influenza A belonging to the RCVG 38 (65.5%) were A (H1N1) pdm09 and 20 (34.5%) A (H3N2). In the hospital setting, of the 603 cases of influenza A, 377 (62.5%) were A (H1N1) pdm09 and 226 (37.5%) were A (H3N2), no significant differences were observed. Conclusions: The 2017-2018 flu season should be considered as an atypical season in which the co-circulation of the four flu types / subtypes determined the highest epidemiological rate and the highest number of cases registered in the Balearic Islands.Introducción: Se analizan las características epidemiológicas y virológicas de la temporada gripal 2017-2018 en sus aspectos de mortalidad y grupos etários. Pacientes y método: Las muestras respiratorias proceden tanto de la Red Centinela de Vigilancia de la Gripe como de los pacientes atendidos en urgencias y hospitalizados en nuestro centro fueron sometidas a la detección de los virus respiratorios mediante una técnica de amplificación genómica comercial, tipo RT-PCR (Allplex Respiratory Panel; Seegen, Corea del Norte), que identifica de forma simultánea y diferencial 16 virus respiratorios distintos. Entre ellos los virus gripales A (H1N1)pdm09 y A(H3N2) y el virus gripal tipo B, aunque no diferencia entre sus dos linajes. Resultados: A lo largo de la temporada gripal se han analizado 6.465 muestras respiratorias, de las cuales 3.228 (49.9%) fueron consideradas positivas (detección de algún virus respiratorio). De ellas, en 1.232 se detectó un virus gripal, representando el 19% de todas las muestras procesadas y el 38.2% de todas las muestras positivas. De todos los virus gripales detectados, 661 (53.6%) fueron identificados como gripe A y 571 (46.4%) gripe B. La RCVG aportó 127 (10.3%) muestras positivas, 58 (8.7%) gripo A y 69 (12%) gripe B. El resto de muestras positivas, 1.105 (89.7%), procedían del ámbito hospitalario, es decir 603 (91.3%) eran gripe A y 502 (88%) eran gripe B. En cuanto a los subtipos de la gripe A se detectaron 415 (62.7%) casos del subtipo A (H1N1) pdm09, 38 (9.1%) de la RCVG y 377 (90.9%) del ámbito hospitalario. Del subtipo A (H3N2) se detectaron 246 (37.3%) casos, de los cuales 20 (8.1%) pertenecían a la RCVG y 226 (91.9%) al ámbito hospitalario. Al analizar los subtipos sobre el total de muestras de cada procedencia se comprueba como de los 58 casos de gripe A pertenecientes a la RCVG 38 (65.5%) eran A (H1N1)pdm09 y 20 (34.5%) A (H3N2). En el ámbito hospitalario, de los 603 casos de gripe A, 377 (62.5%) eran A (H1N1)pdm09 y 226 (37.5%) eran A (H3N2), no observándose diferencias significativas. Conclusiones: La temporada gripal 2017-2018 debe considerarse como una temporada atípica en la que la cocirculación de los cuatro tipos/subtipos gripales determinó la mayor tasa epidemiológica y el mayor número de casos registrado en las Islas Baleares

Seguimiento del primer año de tratamiento antirretroviral en pacientes naive en un hospital de tercer nivel

Resumen Objetivo: El objetivo principal de este trabajo es determinar la tasa de fracaso virológico (FV) en pacientes naive que inician tratamiento antirretroviral (TAR) a 24 y 48 semanas en vida real en un hospital de tercer nivel. Material y método: Estudio retrospectivo de 3 años de duración. Se seleccionaron pacientes adultos VIH naive que iniciaron TAR entre 2012 y 2014. Se registraron datos demográficos (edad, sexo y nacionalidad), clínicos (mecanismo de trasmisión y estadio clínico), de laboratorio (carga viral (CV), linfocitos CD4 basales y existencia de test de mutaciones previo) y TAR elegido. Tras 24 y 48 semanas se registraron: CV y CD4, adherencia, seguimiento, problemas relacionados con la medicación, cambios de TAR y motivos de cambio. Resultados: Se seleccionaron 253 pacientes. 244 y 226 contaban con datos analíticos a las 24 y 48 semanas respectivamente. 142 (58,23%) tenían CV<50 copias/ml y 204 (83,6%) CV<200 copias/ml tras 24 semanas. 198 (88,4%) tenían CV<50 copias/ml y 217 (96,0%) CV<200 copias/ml tras 48. La CV basal superior a 100.000 copias/ml y la mala adherencia se asociaron con un mayor riesgo de FV. Al 30,0% de pacientes se les cambió el TAR durante el primer año, principalmente por efectos secundarios (31,6%) y simplificación del tratamiento (23,7%). Discusión y Conclusiones: Un alto porcentaje de pacientes que inician TAR están indetectables o con menos de 200 copias/ml dentro del primer año de tratamiento. A pesar de tener fármacos altamente eficaces y cada vez mejor tolerados, los efectos secundarios siguen siendo el motivo mayoritario de cambio de TAR

Relationships between Serum Levels of Atazanavir and Renal Toxicity or Lithiasis

The main aim of this study is to describe the relationship between serum levels of atazanavir, renal toxicity, and lithiasis. This is a prospective observational study of patients being treated with atazanavir (ATV) at Son Espases Teaching Hospital, Palma de Mallorca, between 2011 and 2013. The study includes 98 patients. Sixteen were found to have a history of urolithiasis. During a median monitoring period of 23 months, nine patients suffered renal colic, in three of whom ATV crystals were evidenced in urine. Cumulative incidence of renal colic was 9.2 per 100 patients. The variables related to having renal colic were the presence of alkaline urine pH and lower basal creatinine clearance. The mean serum level of ATV was slightly higher in patients with renal colic—1,303 μg/L versus 1,161 μg/L—but did not reach statistical significance. Neither were any significant differences detected by analysing the levels according to the timetable for ATV dosage. Cumulative incidence of renal colic was high in patients being treated with ATV, in 33% of whom the presence of ATV crystals was evidenced in urine. We were unable to demonstrate a relationship between ATV serum levels and renal colic or progression towards renal failure

Epidemiological and clinical characteristics of community-acquired and nosocomial influenza cases and risk factors associated with complications: a four season analysis of all adult patients admitted in a tertiary hospital.

[eng] Background: Information on the characteristics of patients with nosocomial influenza and associated complications is scarce. This study compared epidemiological and clinical characteristics of patients admitted with hospital-acquired influenza (HAI) to those with community-acquired influenza (CAI) and analyzed risk factors associated with complications. Methods: This retrospective, observational study included all adult patients with confirmed influenza virus infection admitted to Son Espases University Hospital during the influenza season in Spain (October to May) from 2012-2013 to 2015-2016. Symptom onset before admission was included as CAI, and 2 days after admission or within 48 hours after previous discharge were considered as HAI. Results: Overall, 666 patients with laboratory-confirmed influenza were included; 590 (88.6%) and 76 (11.4%) had CAI and HAI, respectively. Baseline characteristics and vaccination rates were similar in both groups. Patients with HAI had significantly fewer symptoms, less radiological alterations, and earlier microbiological diagnosis than those with CAI. Eighty-five (14.4%) and 20 (27.6%) CAI and HAI patients, respectively, experienced at least one complication, including septic shock, admission to the intensive care unit, mechanical ventilation or evolution to death (any one, P = .003). Univariate and multivariate binary logistic regression was performed to assess independent risk factors associated with the occurrence of complications: nosocomial infection, diabetes, oseltamivir treatment, having received no vaccination, microbiological delay, dyspnea, and the state of confusion were the most important significant factors. Conclusions: Our study shows the need to implement microbiological diagnostic measures in the first 48 hours to reduce HAI frequency and associated complications