Efecto sobre la mortalidad de la ampliación a los festivos y fines de semana del proyecto "UCI sin paredes". Estudio before-after.

Objetivo: Estudiar si la ampliación, a festivos y fines de semana, del protocolo de detección proactiva precoz de gravedad en el hospital y actuación de intensivistas en planta convencional y urgencias (actividad «UCI sin paredes») se asocia a una reducción en la mortalidad de los pacientes ingresados en UCI en esos días. Diseno: ˜ Estudio cuasiexperimental before---after. Ámbito: Hospital de nivel 2 con 210 camas en funcionamiento y UCI polivalente con 8 camas. Pacientes o participantes: En el grupo control, donde no se realiza la actividad «UCI sin paredes» los fines de semana ni festivos, se incluyeron los pacientes ingresados en la UCI esos días del 1 de enero de 2010 al 30 de abril de 2013. En el grupo intervención se amplió la actividad «UCI sin paredes» a los fines de semana y festivos y se incluyeron los pacientes ingresados esos días del 1 de mayo de 2013 al 31 de octubre de 2014. Se excluyeron los pacientes procedentes de quirófano tras una cirugía programada. Variables de interés: Se analizaron las variables demográficas (edad, sexo), la procedencia (urgencias, planta de hospitalización, quirófano), el tipo de paciente (médico, quirúrgico), el motivo de ingreso, las comorbilidades y el SAPS 3 como puntuación de gravedad al ingreso, estancia en UCI y hospitalaria, además de la mortalidad en la UCI y en el hospital. Resultados: Se incluyeron en el grupo control 389 pacientes, y 161 en el grupo intervención. No se encontraron diferencias entre ambos grupos, salvo en la comorbilidad cardiovascular (un 49% en el grupo control frente a un 33% en el grupo intervención; p < 0,001), en la gravedad al ingreso medida mediante el SAPS 3 (mediana de 52 [percentiles 25---75: 42---63] en el grupo control frente a 48 [percentiles 25---75: 40---56] en el grupo intervención; p = 0,008) y en la mortalidad en UCI, que fue de un 11% en el grupo control (IC 95% 8 a 14) frente al 3% (IC 95% 1 a 7) en el grupo intervención (p = 0,003). En el análisis multivariable, los 2 únicos factores asociados con la mortalidad en UCI fueron: SAPS 3 (OR 1,08; IC 95% 1,06---1,11) y el pertenecer al grupo intervención (OR 0,33; IC 95% 0,12---0,89). Conclusiones: La ampliación de la actividad «UCI sin paredes» a los fines de semana y festivos conlleva un descenso en la mortalidad en la UCI.Objective: To determine whether extension to holidays and weekends of the protocol for the early proactive detection of severity in hospital (‘‘ICU without walls’’ project) results in decreased mortality among patients admitted to the ICU during those days. Design: A quasi-experimental before---after study was carried out. Setting: A level 2 hospital with 210 beds and a polyvalent ICU with 8 beds. Patients or participants: The control group involved no ‘‘ICU without walls’’ activity on holidays or weekends and included those patients admitted to the ICU on those days between 1 January 2010 and 30 April 2013. The intervention group in turn extended the ‘‘ICU without walls’’ activity to holidays and weekends, and included those patients admitted on those days between 1 May 2013 and 31 October 2014. Patients arriving from the operating room after scheduled surgery were excluded. Variables of interest: An analysis was made of the demographic variables (age, gender), origin (emergency room, hospital ward, operating room), type of patient (medical, surgical), reason for admission, comorbidities and SAPS 3 score as a measure of severity upon admission, stay in the ICU and in hospital, and mortality in the ICU and in hospital. Results: A total of 389 and 161 patients were included in the control group and intervention group, respectively. There were no differences between the 2 groups except as regards cardiovascular comorbidity (49% in the control group versus 33% in the intervention group; P < .001), severity upon admission (median SAPS 3 score 52 [percentiles 25---75: 42---63) in the control group versus 48 [percentiles 25---75: 40---56] in the intervention group; P = .008) and mortality in the ICU (11% in the control group [95% CI 8---14] versus 3% [95% CI 1---7] in the intervention group; P = .003). In the multivariate analysis, the only 2 factors associated to mortality in the ICU were the SAPS 3 score (OR 1.08; 95% CI 1.06---1.11) and inclusion in the intervention group (OR 0.33; 95% CI 0.12---0.89). Conclusions: Extension of the ‘‘ICU without walls’’ activity to holidays and weekends results in a decrease in mortality in the ICU.pre-print424 K

Decisions of refusal Intensive Care Units' admission as a measure of limitation of life support treatments: geographical variability in Spain

From a post hoc analysis of the ADENI-UCI study (multicenter, observational, cohort, prospective study, with a follow-up period of 13 months, in 62 Intensive Medicine Services in Spain. geographical differences in the reason for denial of income in UCI as a LTSV measure are analyzed. A total of 2284 with an average age of 75.25 (12.45) years were included. 59.43% male. By means of multinominal regression adjusted by age, sex, APACHE and SOFA, was evident (by choosing the northern for reference) that age in the south was a less significantly exposed reason (OR: 0.48 (IC95%: 0.35-0.65). p

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Análisis del valor predictivo de los criterios de aislamiento preventivo en una unidad de cuidados intensivos.

Objetivo: evaluar la precisión diagnóstica de los criterios empleados para detectar el paciente realmente portador de microrganismos multi-resistentes (MMR) Diseño: Estudio prospectivo, observacional de mayo 2014 a mayo 2015 Ámbito: Unidad de Cuidados Intensivos polivalente. Pacientes cohorte de pacientes ingresados de forma consecutiva que cumplían los siguientes criterios de aislamiento preventivo: hospitalización de más de 4 días en los últimos 3 meses (“hospital”); antibioterapia durante una semana en el último mes (“antibiótico”), pacientes institucionalizados o en contacto con cuidados sanitarios (“institución o cuidado”); portador de MMR los últimos 6 meses (“MMR previo”). Variables: edad, sexo, Simplified Acute Physiology Score 3, tipo de paciente (médico vs quirúrgico), estancia en UCI, mortalidad en UCI, mortalidad hospitalaria y tiempo de aislamiento. Se realizó un análisis multivariable con regresión logística múltiple entre cada uno de los factores de riesgo y el que el paciente fuera realmente portador de MMR. Resultados: Durante el periodo de estudio ingresaron 575 pacientes y cumplieron los criterios un 28%. De los 162 pacientes con criterios 51 (31%) eran portadores de MMR y de los que no cumplían criterios 29 (7%) sí que tenían portadores. En el análisis multivariable la única variables asociada de forma independiente con el ser portador fue “MMR previo” con una OR 12.14 (IC 95% 4.24 - 34.77) Conclusiones El único criterio que se asoció de forma independiente con la capacidad de detectar los pacientes con MMR al ingreso en la UCI fue haber presentado un “MMR previo”pre-print229 K

The Consumption of Food-Based Iodine in the Immediate Pre-Pregnancy Period in Madrid Is Insufficient. San Carlos and Pregnancy Cohort Study

A pre-gestational thyroid reserve of iodine is crucial to guarantee the increased demand for thyroid hormone production of early pregnancy. An iodine intake &ge;150 &micro;g/day is currently recommended. The objective of this study was to assess average pre-gestational food-based iodine consumption in pregnant women at their first prenatal visit (&lt;12 gestational weeks), and its association with adverse materno-fetal events (history of miscarriages, early fetal losses, Gestational Diabetes, prematurity, caesarean sections, and new-borns large/small for gestational age). Between 2015&ndash;2017, 2523 normoglycemic women out of 3026 eligible had data in the modified Diabetes Nutrition and Complication Trial (DNCT) questionnaire permitting assessment of pre-gestational food-based iodine consumption, and were included in this study. Daily food-based iodine intake was 123 &plusmn; 48 &micro;g, with 1922 (76.1%) not reaching 150 &micro;g/day. Attaining this amount was associated with consuming 8 weekly servings of vegetables (3.84; 3.16&ndash;4.65), 1 of shellfish (8.72; 6.96&ndash;10.93) and/or 2 daily dairy products (6.43; 5.27&ndash;7.86). Women who reached a pre-gestational intake &ge;150 &micro;g had lower rates of hypothyroxinemia (104 (17.3%)/384 (21.4%); p = 0.026), a lower miscarriage rate, and a decrease in the composite of materno-fetal adverse events (0.81; 0.67&ndash;0.98). Reaching the recommended iodine pre-pregnancy intake with foods could benefit the progression of pregnancy

Modifiable Risk Factors and Trends in Changes in Glucose Regulation during the First Three Years Postdelivery: The St Carlos Gestational Diabetes Mellitus Prevention Cohort

Author Contributions: M.A.-R., A.B., A.L.C.-P., A.D., P.M.-M., M.A.R., P.d.M., J.A.D., L.d.V., V.M., J.V., I.R., M.P. and R.M.O. were involved in conceptualization and design, data curation, analysis, and interpretation of data. A.L.C.-P. was responsible for funding acquisition. A.L.C.-P., C.F., I.M., I.J., M.A.-R., M.J.T., M.M.-N., M.P., A.D., P.d.M., A.B., L.d.V., V.M., J.V. and R.M.O. were involved in supervision, validation, and visualization of researched data, and contributed to discussion and investigation. M.C., M.P., P.M.-M., M.A.-R. and M.A.R. were involved in data research and reviewed and edited the manuscript. Writing—original draft: A.L.C.-P., M.A.-R., V.M., I.R. and P.M.-M. wrote the first draft of the manuscript. Writing—review & editing: M.A.-R., A.L.C.-P., P.M.-M., V.M., and I.R. A.L.C.-P. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors have read and agreed to the published version of the manuscript.Objective: Evaluation of the influence of potential risk factors (RFs) on glycemic changes at 3 years postpartum. Methods: The glycemic status of 1400 women, in absence of a new pregnancy, was evaluated at 3 months (3 m) and 3 years (3 y) postpartum, after participation in the St. Carlos Gestational Study (2228 normoglycemic pregnant women followed from before gestational week 12 to delivery, from 2015–2017). Abnormal glucose regulation (AGR) was defined as fasting serum glucose ≥ 100 mg/dL and/or HbA1c ≥ 5.7% and/or 2 h 75 g OGTT glucose ≥ 140 mg/dL. In total, 12 modifiable and 3 unmodifiable RFs were analyzed. Results: 3 m postpartum, 110/1400 (7.9%) women had AGR; 3 y postpartum, 137 (9.8%) women exhibited AGR (110 with 3 m normal glucose tolerance [NGT]); 1263 (90.2%) had NGT (83 with 3 m AGR). More women with gestational diabetes mellitus (GDM) progressed to AGR at 3 y (OR: 1.60 [1.33–1.92]) than women without GDM. Yet, most women with 3 m and/or 3 y AGR had no GDM history. Having ≥2 unmodifiable RFs was associated with increased risk for progression to AGR (OR: 1.90 [1.28–2.83]) at 3 y postpartum. Having >5/12 modifiable RFs was associated with increased progression from NGT to AGR (OR: 1.40 [1.00–2.09]) and AGR persistence (OR: 2.57 [1.05–6.31]). Pregestational BMI ≥ 25 kg/m2 (OR: 0.59 [0.41–0.85]), postdelivery weight gain (OR: 0.53 [0.29–0.94]), and waist circumference > 89.5 cm (OR: 0.54 [0.36–0.79]) reduced the likelihood of NGT persisting at 3 y. Conclusions: 3-month and/or 3-year postpartum AGR can be detected if sought in women with no prior GDM. Modifiable and unmodifiable RF predictors of AGR at 3 y postpartum were identified. Universal screening for glycemic alterations should be considered in all women following delivery, regardless of prior GDM. These findings could be useful to design personalized strategies in women with risk factors for 3 y AGR.Ministerio de Ciencia, Innovación y Universidades (España)Depto. de MedicinaFac. de MedicinaTRUEpu