Comparación de las características y pronóstico de la infección por SARS-COV-2 en pacientes hospitalizados con EPOC en la primera y segunda ola en un hospital de tercer nivel

La EPOC se asocia a mayor severidad y mortalidad en la COVID-19. Se realizó un estudio transversal para evaluar las características y el pronóstico de la infección por SARS-CoV-2 en los pacientes con EPOC que ingresaron en la primera ola respecto a los de la segunda. Se incluyeron pacientes con antecedente de EPOC según la historia clínica e ingreso por COVID-19. Se recogieron los resultados de las diferentes variables y se realizó un análisis bivariado entre las variables de ambas olas y su mortalidad asociada. Se obtuvo un total de 291 pacientes, 156 de la primera ola y 135 de la segunda. En la segunda ola los pacientes fueron más jóvenes y presentaron menor mortalidad (25,2% vs 38,5%). En la segunda ola hubo más casos sin neumonía (60,5% vs 39,5%) y menos de neumonía bilateral (37,3% vs 62,7%, p=0,007) y los pacientes recibieron más remdesivir (96,6% vs 3,4%, p<0,001) y corticoides (59,0% vs 41,0%, p<0,001). No hubo diferencias en los parámetros analíticos ni en las terapias ventilatorias entre ambas olas. Los menores de 80 años presentaron menor mortalidad en la segunda ola (16,1% vs 30,8%, p=0,021), así como los que recibieron corticoides (26,9% vs 41,3%, p=0,04). Son necesarios más estudios para definir el tratamiento idóneo de la COVID-19 en pacientes con EPOC y qué características condicionan su pronóstico.COPD is associated with greater severity and mortality in COVID-19. A crosssectional study was conducted to evaluate the characteristics and prognosis of SARSCoV-2 infection in hospitalized COPD patients in the first wave compared to those in the second wave. It was included patients with a history of COPD according to their clinical history and diagnosed with COVID-19. The results of the different variables were collected and it was performed a bivariate analysis between the variables of both waves and their associated mortality. A total of 291 patients were obtained, 156 from the first wave and 135 from the second. In the second wave, patients were younger and had lower mortality (25,2% vs 38,5%). In the second wave, there were more cases without pneumonia (60,5% vs 39,5%) and less with bilateral pneumonia (37,3% vs 62,7%, p=0,007) and patients received more remdesivir (96,6% vs 3,4%, p<0,001) and corticosteroids (59,0% vs 41,0%, p<0.001). There were no differences in the analytical results or ventilatory therapies between the two waves. Patients under the age of 80 had lower mortality in the second wave (16,1% vs 30,8%, p=0,021), as well as those who received corticosteroids (26,9% vs 41,3%, p=0,04). More studies are needed to define the ideal treatment for COVID-19 in COPD patients as well as which characteristics determine their prognosis

Update on Extended Treatment for Venous Thromboembolism

The importance of assessing the probability of venous thromboembolism recurrence, a condition that includes deep vein thrombosis and pulmonary embolism, lies in the fact that it is the most important factor in deciding the duration of anticoagulant treatment. Risk of recurrence depends mostly on the presence of a risk factor for developing venous thromboembolism, with patients with unprovoked events being at the higher risk of recurrence. The risk of recurrence needs to be balanced with the risk of bleeding and the potential severity of these thrombotic and hemorrhagic events. In patients with an unprovoked venous thromboembolism who complete treatment for the acute (first 10 days) and post-acute phase of the disease (from day 10 to 3-6 months), decision has to be made regarding prolonged antithrombotic therapy to prevent recurrences. The main goal of extended treatment is preventing recurrences with a safe profile in terms of bleeding risk. Many therapeutic options are now available for these patients, including antiplatelet therapy with aspirin or direct oral anticoagulants. Moreover, apixaban and rivaroxaban at prophylactic doses have demonstrated efficacy in preventing recurrences with a low risk of bleeding

Healthcare workers hospitalized due to COVID-19 have no higher risk of death than general population. Data from the Spanish SEMI-COVID-19 Registry

Aim To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW). Methods Observational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. Results As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age, male sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.211, 95%CI 0.067-0.667, p = 0.008). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). Conclusions Hospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality

Clinical Characteristics and Risk Factors of Respiratory Failure in a Cohort of Young Patients Requiring Hospital Admission with SARS-CoV2 Infection in Spain: Results of the Multicenter SEMI-COVID-19 Registry.

Age is a risk factor for COVID severity. Most studies performed in hospitalized patients with SARS-CoV2 infection have shown an over-representation of older patients and consequently few have properly defined COVID-19 in younger patients who require hospital admission. The aim of the present study was to analyze the clinical characteristics and risk factors for the development of respiratory failure among young (18 to 50 years) hospitalized patients with COVID-19. This retrospective nationwide cohort study included hospitalized patients from 18 to 50 years old with confirmed COVID-19 between March 1, 2020, and July 2, 2020. All patient data were obtained from the SEMI-COVID Registry. Respiratory failure was defined as the ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2 ratio) ≤200 mmHg or the need for mechanical ventilation and/or high-flow nasal cannula or the presence of acute respiratory distress syndrome. During the recruitment period, 15,034 patients were included in the SEMI-COVID-19 Registry, of whom 2327 (15.4%) were younger than 50 years. Respiratory failure developed in 343 (14.7%), while mortality occurred in 2.3%. Patients with respiratory failure showed a higher incidence of major adverse cardiac events (44 (13%) vs 14 (0.8%), p320 U/I (OR, 1.69; 95% CI, 1.18 to 2.42; p=0.0039), AST >35 mg/dL (OR, 1.74; 95% CI, 1.2 to 2.52; p=0.003), sodium 35 mg/dL (OR, 1.74; 95% CI, 1.2 to 2.52; p=0.003), sodium 8 mg/dL (OR, 2.42; 95% CI, 1.72 to 3.41; p Young patients with COVID-19 requiring hospital admission showed a notable incidence of respiratory failure. Obesity, SAHS, alcohol abuse, and certain laboratory parameters were independently associated with the development of this complication. Patients who suffered respiratory failure had a higher mortality and a higher incidence of major cardiac events, venous thrombosis, and hospital stay