Predictive Factors of Pulmonary Embolism in Older Patients with SARS-CoV-2: The OCTA-COVID-19 Study

Background: The risk of pulmonary embolism (PE) has not been studied in older patients affected by COVID-19. We aimed to assess PE incidence and risk factors in a population of older patients infected with SARS-CoV-2. Methods: An ambispective, observational cohort study. A total of 305 patients >= 75 years old had the SARS-CoV-2 infection from March to May 2020. The incidence rate of PE was estimated as the proportion of new cases within the whole sample. Youden's index was used to assess the cutoff point of D-dimer. To select factors associated with the risk of PE, time-to-event analyses were performed using cause-specific hazard models. Results: In total, 305 patients with a median age of 87 years (62.3% female) were studied; 67.9% were referred from nursing homes and 90.4% received any type of anticoagulation. A total of 64.9% showed frailty and 44% presented with dementia. The PE incidence was 5.6%. The cutoff value of a D-dimer level over 2.59 mg/L showed a sensitivity of 82.4% and specificity of 73.8% in discriminating a PE diagnosis. In the multivariate analysis, the factors associated with PE were previous oncological events and D-dimer levels. Conclusions: The PE incidence was 5.6%, and major risk factors for PE were oncological antecedents and increased plasma D-dimer levels.This work was partially supported by grants (to M.Q.-F., J.G.-P.) from the "New announcement for extraordinary initiative fund UAX-Santander COVID-19," Alfonso X el Sabio University

Chikungunya virus infections among travellers returning to Spain, 2008 to 2014

Since the first documented autochthonous transmission of chikungunya virus in the Caribbean island of Saint Martin in 2013, the infection has been reported within the Caribbean region as well as North, Central and South America. The risk of autochthonous transmission of chikungunya virus becoming established in Spain may be elevated due to the large numbers of travellers returning to Spain from countries affected by the 2013 epidemic in the Caribbean and South America, as well as the existence of the Aedes albopictus vector in certain parts of Spain. We retrospectively analysed the laboratory diagnostic database of the National Centre for Microbiology, Institute of Health Carlos III (CNM-ISCIII) from 2008 to 2014. During the study period, 264 confirmed cases, of 1,371 suspected cases, were diagnosed at the CNM-ISCIII. In 2014 alone, there were 234 confirmed cases. The highest number of confirmed cases were reported from the Dominican Republic (n = 136), Venezuela (n = 30) and Haiti (n = 11). Six cases were viraemic in areas of Spain where the vector is present. This report highlights the need for integrated active case and vector surveillance in Spain and other parts of Europe where chikungunya virus may be introduced by returning travellers

Circulating carotenoids are associated with favorable lipid and fatty acid profiles in an older population at high cardiovascular risk

Carotenoid intake has been reported to be associated with improved cardiovascular health, but there is little information on actual plasma concentrations of these compounds as biomarkers of cardiometabolic risk. The objective was to investigate the association between circulating plasma carotenoids and different cardiometabolic risk factors and the plasma fatty acid profile. This is a cross-sectional evaluation of baseline data conducted in a subcohort (106 women and 124 men) of an ongoing multi-factorial lifestyle trial for primary cardiovascular prevention. Plasma concentrations of carotenoids were quantified by liquid chromatography coupled to mass spectrometry. The associations between carotenoid concentrations and cardiometabolic risk factors were assessed using regression models adapted for interval-censored variables. Carotenoid concentrations were cross-sectionally inversely associated with serum triglyceride concentrations [-2.79 mg/dl (95% CI: -4.25, -1.34) and -5.15 mg/dl (95% CI: -7.38, -2.93), p-values = 0.0002 and <0.00001 in women and men, respectively], lower levels of plasma saturated fatty acids [-0.09% (95% CI: -0.14, -0.03) and -0.15 % (95% CI: -0.23, -0.08), p-values = 0.001 and 0.0001 in women and men, respectively], and higher levels of plasma polyunsaturated fatty acids [(0.12 % (95% CI: -0.01, 0.25) and 0.39 % (95% CI: 0.19, 0.59), p-values = 0.065 and 0.0001 in women and men, respectively] in the whole population. Plasma carotenoid concentrations were also associated with higher plasma HDL-cholesterol in women [0.47 mg/dl (95% CI: 0.23, 0.72), p-value: 0.0002], and lower fasting plasma glucose in men [-1.35 mg/dl (95% CI: -2.12, -0.59), p-value: 0.001]. Keywords: Mediterranean diet; PREDIMED-plus study; cardiovascular health; liquid chromatography; mass spectrometry; plasma carotenoids

Adopting a High-Polyphenolic Diet Is Associated with an Improved Glucose Profile: Prospective Analysis within the PREDIMED-Plus Trial

Previous studies suggested that dietary polyphenols could reduce the incidence and complications of type-2 diabetes (T2D); although the evidence is still limited and inconsistent. This work analyzes whether changing to a diet with a higher polyphenolic content is associated with an improved glucose profile. At baseline, and at 1 year of follow-up visits, 5921 participants (mean age 65.0 ± 4.9, 48.2% women) who had overweight/obesity and metabolic syndrome filled out a validated 143-item semi-quantitative food frequency questionnaire (FFQ), from which polyphenol intakes were calculated. Energy-adjusted total polyphenols and subclasses were categorized in tertiles of changes. Linear mixed-effect models with random intercepts (the recruitment centers) were used to assess associations between changes in polyphenol subclasses intake and 1-year plasma glucose or glycosylated hemoglobin (HbA1c) levels. Increments in total polyphenol intake and some classes were inversely associated with better glucose levels and HbA1c after one year of follow-up. These associations were modified when the analyses were run considering diabetes status separately. To our knowledge, this is the first study to assess the relationship between changes in the intake of all polyphenolic groups and T2D-related parameters in a senior population with T2D or at high-risk of developing T2

Impact of delirium on short‐term outcomes in hip fracture patients under a program of approach to delirium

Aim:We aimed to investigate the impact of delirium on short-term outcomes in hip fracturepatients. Special attention was given to patients with delirium and dementia.Methods:A prospective observational cohort study was carried out in hip fracture patientsaged≥70 years who were admitted to a hospital unit where a multicomponents approach todelirium is established for all patients. Our population was split into delirium (n= 212) andnon-delirium cohort (n= 171) according to the Confusion Assessment Method. Patients witha previous diagnosis of dementia in an outpatient appointment were also assessed within thedelirium cohort. The utility of the rehabilitation was measured with the Absolute FunctionalGain index.Results:A total of 383 patients were entered into the study. The median age was 86 years,and most patients were women (78.8%). Delirium patients were older, presented a lower pre-vious Barthel Index (BI), had higher rates of dementia and came more frequently from nursinghomes. Comparative analysis did not show differences in mortality, complications, length ofstay or walking ability between the cohorts. However, lower BI on discharge, lower AbsoluteFunctional Gain and the presence of nosocomial infections were found more frequently inthe delirium cohort. In multivariate analysis, only the BI on discharge (P= 0.010) was lower indelirium patients. Within the delirium cohort, those suffering from dementia had worse BI ondischarge (P= 0.017) and lower Absolute Functional Gain (P= 0.019).Conclusions:Delirium was not associated with mortality, walking ability, length of stay andclinical complications in hip fracture patients. BI on discharge was the only short-term out-come affected. In the delirium cohort, those suffering from dementia showed worse rehabili-tation results.Sin financiación2.022 JCR (2019) Q2, 14/36 Gerontology0.844 SJR (2019) Q1, 10/41 Gerontology, 55/301 Health (social science)No data IDR 2019UE

Impact of delirium on short-term outcomes in hip fracture patients under a program of approach to delirium

Aim:We aimed to investigate the impact of delirium on short-term outcomes in hip fracturepatients. Special attention was given to patients with delirium and dementia.Methods:A prospective observational cohort study was carried out in hip fracture patientsaged≥70 years who were admitted to a hospital unit where a multicomponents approach todelirium is established for all patients. Our population was split into delirium (n= 212) andnon-delirium cohort (n= 171) according to the Confusion Assessment Method. Patients witha previous diagnosis of dementia in an outpatient appointment were also assessed within thedelirium cohort. The utility of the rehabilitation was measured with the Absolute FunctionalGain index.Results:A total of 383 patients were entered into the study. The median age was 86 years,and most patients were women (78.8%). Delirium patients were older, presented a lower pre-vious Barthel Index (BI), had higher rates of dementia and came more frequently from nursinghomes. Comparative analysis did not show differences in mortality, complications, length ofstay or walking ability between the cohorts. However, lower BI on discharge, lower AbsoluteFunctional Gain and the presence of nosocomial infections were found more frequently inthe delirium cohort. In multivariate analysis, only the BI on discharge (P= 0.010) was lower indelirium patients. Within the delirium cohort, those suffering from dementia had worse BI ondischarge (P= 0.017) and lower Absolute Functional Gain (P= 0.019).Conclusions:Delirium was not associated with mortality, walking ability, length of stay andclinical complications in hip fracture patients. BI on discharge was the only short-term out-come affected. In the delirium cohort, those suffering from dementia showed worse rehabili-tation results.Sin financiación2.730 JCR (2020) Q2, 15/36 Gerontology0.823 SJR (2020) Q1, 10/41 GerontologyNo data IDR 2020UE

Accuracy, feasibility and predictive ability of different frailty instruments in an acute geriatric setting. European geriatric medicine

To analyze the feasibility, accuracy and the ability of different frailty instruments to predict adverse outcomes. Methods A prospective cohort study was conducted in patients ≥ 70 years admitted to the acute care setting (ACS). Feasibility and prevalence of frailty were assessed by FRAIL, Clinical Frailty Scale (CFS), hand grip strength (HGS) and the Spanish Frailty-VIG. Receiver operator characteristic (ROC) curves and area under the curve (AUC) were performed to identify frailty according to each instrument, setting VIG as the reference. For each instrument, multiple logistic regressions were used to examine the effect of frailty on primary outcome (i.e., three-month mortality) and secondary outcomes (i.e., in-hospital mortality, length of stay, institutionalization, functional decline and 30-day readmission). Results A total of 185 patients were included, with a median age of 89 years. The feasibility of the instruments was 100%, except for HGS (67%). The prevalence of frailty varied from 65.2% (FRAIL) to 86.7% (VIG). AUCs against VIG ranged from 0.69 (95% confidence interval [CI] 0.57–0.81: FRAIL) to 0.77 (95% CI 63.5–90.2: CFS). Frail patients defined by FRAIL were 2.7times more likely to have a prolonged length of stay than non-frail patients (95% CI 1.385–5.416). Three-month mortality occurred more among frail patients, either defined by FRAIL (OR 2.5; 95% CI 1.072–5.881) or CFS (OR 3.7; 95% CI 1.255–10.812), than in non-frail patients. Conclusion The four instruments had high feasibility providing variable prevalence of frailty. FRAIL and CFS predicted well for three-month mortality, and FRAIL also for length of stay. However, none of the instruments predicted for the other secondary outcomes of the study.Sin financiación3.269 JCR (2021) Q3, 36/54 Geriatrics & Gerontology0.670 SJR (2021) Q2, 52/110 Geriatrics and GerontologyNo data IDR 2020UE

Near-normal aerobic capacity in long-term survivors after lung transplantation

The aim of this study was to elucidate whether long-term LT survivors with normal spirometry achieve normal exercise capacity, and to identify predictive factors of exercise capacity. This was a cross-sectional multicentre study, where bilateral LT recipients who survived at least 10 years after LT, with normal spirometry, no diagnosis of CLAD and modified Medical Research Council dyspnoea degree ≤2 underwent cardiopulmonary exercise testing (CPET). 28 LT recipients were included with a mean± age of 48.7±13.6 years. Oxygen uptake (V' ) had a mean± value of 21.49±6.68 mL·kg −1 ·min −1 (75.24±15.6%) and the anaerobic threshold was reached at 48.6±10.1% of the V' predicted. The mean± heart rate reserve at peak exercise was 17.56±13.6%. The oxygen pulse increased during exercise and was within normal values at 90.5±19.4%. The respiratory exchange ratio exceeded 1.19 at maximum exercise. The median (25-75 th percentile) EuroQol-5D score was 1 (0.95-1), indicating a good quality of life. The median (25-75 th percentile) International Physical Activity Questionnaire score was 5497 (4007-9832) MET-min·week −1 with 89% of patients reporting more than 1500 MET-min·week −1. In the multivariate regression models, age, sex and diffusing capacity of the lung for carbon monoxide remained significantly associated with V' (mL·kg −1 ·min −1); haemoglobin and forced expiratory volume in 1 s were significantly associated with maximum work rate (watts), after adjusting for confounders. We report for the first time near-normal peak V' values during CPET and normal exercise capacity in long-term LT recipients without CLAD. This is a multicentre study reporting, for the first time, near-normal peak V ' values during cardiopulmonary exercise testing and normal exercise capacity in long-term lung transplant recipients without CLA